Health Affairs | VOL. 41
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In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians

Publication Date May 1, 2022

Abstract

States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access to care, many states set network adequacy standards that require plans to contract with a minimum number of physicians. In this study we used data from the period 2015-17 for four states to assess the level of Medicaid participation among physicians listed in the provider network directories of each managed care plan. We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year. Care was highly concentrated: 25percent of primary care physicians provided 86percent of the care, and 25percent of specialists, on average, provided 75percent of the care. Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries' preferences and physicians' willingness to serve Medicaid patients.

Concepts

Managed Care Plans Medicaid Managed Care Plans Medicaid Managed Care Primary Care Physicians Managed Care Outpatient Specialist Primary Care Outpatient Physicians Level Of Participation Provision Of Services

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