June 7, 2013
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Compared to privately insured patients, Medicaid patients are much more likely to face difficulties finding specialists willing to accept them as patients. The study examined six specialty care modelsin Connecticut, Illinois, Minnesota, New Mexico, Oregon, and Tennesseethat support innovative ways of delivering specialty care and ensure specialty referrals for Medicaid patients are appropriate and efficient.
“Strategies include finding ways for specialty providers to deliver care at primary care facilities, expanding the role of primary care providers to deliver specialty care, and employing staff to focus on communication and coordination across providers. Although resources remain limited, participating organizations report better access to specialty care for Medicaid patients and early signs of improvements in quality and costs of care. However, sustaining, expanding, and replicating these models may require changes in Medicaid payment methods that recognize new types of interactions with patients beyond face-to-face visits,” according to the study.
The study was coauthored by Laurie E. Felland, M.S., HSC senior researcher and director of qualitative research; Amanda E. Lechner, M.P.P., HSC health policy analyst; and Anna Sommers, Ph.D., a former HSC senior researcher now at the Medicaid and CHIP Payment Advisory Commission. The study findings are detailed in a new Commonwealth Fund reportImproving Access to Specialty Care for Medicaid Patients: Policy Issues and Options—available online here.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.