Increase Medicaid access to specialists

Medicaid expansion across the country will undoubtedly put further strain on access to providers for what is typically a high-need population. Many patients have problems accessing specialists in particular, according to the Commonwealth Fund. The organization examined care-delivery models in Connecticut, Illinois, Minnesota, New Mexico, Oregon and Tennessee, and identified best practices and recommendations for further development.

1

Current Model

Increase the availability of specialty care through technology; by bringing specialists to primary care sites; and by using physician assistants to deliver specialty services.

Example

Community Health Centers Inc. uses store-and-forward technology that collects images for later review by an ophthalmologist to screen for early signs of blindness in diabetic patients.

2

Current Model

Expand the role of primary care providers, including physicians and nurse practitioners, to handle more specialized health issues through training and the use of electronic consultations.

Example

Project ECHO specialists at the University of New Mexico guide and train primary care providers with remote video conferencing. In time, providers are able to treat patients with specialized health issues independently.

3

Current Model

Enhance communication and coordination among patients, primary care providers and specialists through broad medical-home models and through use of access coordinators who can arrange specialty care.

Example

Minnesota Health Care Homes broadens the medical home concept to a “medical neighborhood” that includes a wider team of clinicians and support staff to coordinate care and form relation­ships and improve communication with medical and surgical specialists.

4

Future Model

Change payment models to encourage improvement and innovation. Pay providers to consult with other clinicians to treat patients remotely and pay for nonclinical activities such as care coordination. Surveys indicate physicians are relatively unwilling to serve Medicaid because of low payment and high administrative burden.

Example

One alternative to direct payments for vari­ous strategies is to move toward fixed payments for patients’ overall care rather than fee-for-service arrange­ments. Health care reform encourages development of accountable care organizations (ACOs) and other new payment arrangements designed to improve both the quality and efficiency of care delivery.

Additional Resources

“Improving Access to Specialty Care for Medicaid Patients: Policy Issues and Options”

“Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States”

State-by-state scorecard on service for low-income populations

“Enhancing the Capacity of Community Health Centers to Achieve High Performance”