Original Publish Date: February 9, 2016
A lot is expected of Washington’s primary care providers.
While the Affordable Care Act and Washington’s participation in Medicaid expansion has reduced the number of uninsured Washingtonians from 14% to 7%, the majority of newly insured are receiving coverage through Medicaid. This poses a challenging responsibility to primary care.
Patients, often with complex medical and/or psycho social needs require clinical and nonclinical resources, education, and time. These are all essential components of quality care, but are nearly impossible to provide on Medicaid rates alone. Sacrificing quantity for quality to keep clinic doors open, but is not a member-centric, quality driven, sustainable practice model. An increasing number of Primary Care Providers (PCPs) either no longer accept Medicaid, or have closed their practices to new Medicaid patients due to the very low rate of Medicaid reimbursement for essential primary care services. In fact, Washington-based studies indicate that while 80% of PCPs are accepting new patients, 30% no longer accept new Medicaid patients. At least 14 counties in Washington have a shortage of primary care providers. Furthermore, the lack of access drives high utilization rates seen as in Washington’s hospitals and emergency departments.
For many providers however, the mission of serving the underserved within their communities remains core to their philosophy and values. Molina Healthcare shares this mission, and believes that a fundamental step to support these dedicated providers is advocacy for increased PCP reimbursement.
A recent study in the New England Journal of Medicine linked higher reimbursement rates to increased availability of primary care appointments, and legislation currently proposed in our state is aimed to do just that. Washington Senate bill 6272 would require a Medicaid raise for primary care physicians on par with Medicare rates.
While appropriate reimbursement is one solution to reduce the challenges of caring for our vulnerable populations, another is providing additional resources to primary care providers. The value a care coordinator, patient educator, MSW, care navigator or case manager can bring to a practice is arguably as critical as enhanced reimbursement and financial incentives.
Take, for example, preventive care. Well child visits, immunizations, screening and prevention are critical to the prevention of chronic conditions and eradication of disease. Yet the constraints of traditional primary care practice often preclude the provider’s ability to educate and execute on USPSTF and other evidence based guidelines. The time to overcome language, behavioral and cultural barriers may at best be slow, and at worst prevent essential care. Most primary care practices have limited bandwidth, and many providers are doing all they can just to get through the scheduled appointments they have booked each day for acute and urgent issues. Adding education, preventive and wellness visits to an already packed schedule is often just not tenable.
This is where a healthcare plan like Molina can make a big difference. It becomes about provider relationships, member relationships, and innovative partnerships in care.
Examples of such collaboration include supporting clinic resources with Molina-based resources such as staffing to coordinate members’ care; providing outreach and scheduling assistance to improve compliance with needed tests and services; co-locating care coordinators or MSWs in clinics to help address the physical and behavioral health needs of high-risk patients; and securing the foundational social determinants of a member’s care so that medical concerns can be more successfully addressed. Other resources may include expertise-specific to topics such as EMR workflow optimization, ICD-10 coding education, and risk adjustment education.
Supporting providers’ patients with around the clock virtual urgent care services, or supporting telehealth programs in areas where PCP resources are the scarcest, highlights another avenue where Molina can work in concert with providers to find solutions to address better access and appropriate quality care.
Primary care is fundamental to maintaining quality, and lowering the overall cost of health care for Medicaid members. Comprehensive primary care keeps patients out of hospitals and emergency rooms for non- emergent conditions. The proper financial incentivization of providers to treat our Medicaid members is a must, and further supporting their efforts with services tailored to their practices and patient demographics is an opportunity to find effective solutions together.
Though companies like Molina cannot add hours to the day, they can support primary care providers in continuing the essential work they do, and in finding solutions that together may add quality years to patients’ lives.
Visit Molina Healthcare at www.molinahealthcare.com