Author: James M. Verdier, Vivian Byrd, Christal Stone, Mathematica Policy Research, Inc.
September 2009 | Resource Paper
Since the early 1980s, state Medicaid programs have been operating primary care case management programs (PCCM) that link beneficiaries to primary care providers and pay providers for a core set of care management activities. Beginning in the 1990s, and increasingly today, states have sought to enhance basic PCCM programs by adding more intensive care management and care coordination for high-need beneficiaries, improved PCP incentives, and increased use of performance measures.
Enhanced Primary Care Case Management Programs in Medicaid: Issues and Options for States examines enhanced PCCM programs in five states — Oklahoma, North Carolina, Pennsylvania, Indiana, and Arkansas. The paper builds on an in-depth evaluation that Mathematica Policy Research, Inc. completed of Oklahoma’s SoonerCare Choice enhanced PCCM program. It describes several options for enhancing PCCM programs with a focus on strategies that can improve care management for beneficiaries with chronic illnesses and disabilities. The paper is aimed at states that are seeking to create accountable systems of care, particularly for beneficiaries with complex needs, but may not have the option of contracting with fully capitated managed care organizations and/or want to consider non-capitated options.