Attracting specialists to serve the Medicaid population

By Meshie Knight

Numbers released this week from Access Health CT indicate that over 71,000 individuals have enrolled in the state’s Medicaid/Husky plan since October, many of them qualifying for coverage for the first time thanks to the Affordable Care Act (ACA).  That means many more people seeking to use their new coverage to seek care.

Fortunately, as reported in a recent CT Mirror article the number of clinicians participating in the program, particularly physicians and nurse practitioners who deliver primary care, is on the rise.  This is in part thanks to enhanced payment levels funded by the ACA, which provides federal funds to bring Medicaid rates for primary care providers (PCPs) up to the same level as Medicare rates.  Although federal support for this increase is only available through October, 2013, Governor Malloy’s budget proposes to use state funds to continue to pay PCPs at the higher rate, to try to retain and attract even more of them to serve Medicaid/Husky patients.

But as the article points out, “The additional primary care doctors could help ease access, although advocates have noted that it doesn’t help with another challenge — getting specialists to see Medicaid patients.”

Since it will be difficult, if not impossible to fund rate increases to attract more specialists to Medicaid, other approaches need to be explored.  There are many innovative options being tried, particularly in community health center settings.  One strategy includes bringing specialists to primary care practices remotely through e-Consults. This approach helps specialists to communicate with PCPs electronically via secure email or using electronic medical records in order to respond to questions and provide guidance about patient management. An e-Consult can help determine whether a specialist patient visit is truly needed, and that if it does occur that the specialist has all of the information needed to evaluate the patient.

Another initiative is Project ECHO (an acronym for Extension for Community Healthcare Outcomes.) Project ECHO utilizes specialists to train primary care providers to treat conditions through videoconferencing and remote consults.  Locally, Community Health Center, Inc. participates in several Project ECHO programs including one to get expert help with pain management.

recent report published by The Commonwealth Fund finds that electronic consultation between primary care physicians and specialists can improve access, lead to better quality and patient satisfaction as well as reduce costs.  While these interventions work better for some specialties than others, they are an innovative way to help address the chronic lack of access to specialty care for Medicaid patients in Connecticut.

Given concerns about the high cost of care and overuse of unnecessary procedures, privately insured patients could greatly benefit from e-consults, too.  As everyone gains access to improved primary care with good coordination and an emphasis on prevention, the most positive outcome will be that people will develop fewer chronic conditions and overall demand for specialty care will decrease over time.

Meshie Knight is the Program & Development Associate at Universal Health Care Foundation of Connecticut.

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