Most employed medical groups can't do the same. Their parent health systems often have a cultural (and tax status-required) commitment to serve the entire community. More practically, turning Medicaid patients away from ambulatory care increases the risk that they will use the emergency department (ED) instead, driving up health system costs.
So, employed medical groups must instead find ways to strengthen access to ambulatory services for Medicaid patients—without crowding out other populations. Our research finds they have three options for doing so, though they are not mutually exclusive and are often used in combination.
Option 1: Partner with existing community clinics
Depending on market dynamics, the most effective way to provide ambulatory access to Medicaid patients may be to partner with someone else in the community who already serves that population, such as a federally qualified health center (FQHC).
However, medical groups should recognize that partnership does not simply mean diverting patients. Rather, effective partnerships include direct and indirect support for the community clinic's activities, as well as strategies to aid expansion of specialty care capabilities that community clinics often lack.
Option 2: Establish own Medicaid-focused clinic
Diverting patients to a community-based provider may not be feasible if there isn't a good partner in the market. In that case, some health systems have chosen to create their own Medicaid-focused primary care clinics.
However, because regulatory restrictions generally prevent hospitals from operating FQHCs, such clinics do not qualify for enhanced Medicaid reimbursement. So, before taking this step, health systems and medical groups should carefully consider the economic realities of this investment. Many who choose to invest in Medicaid clinics do so primarily to reduce unnecessary ED costs.
Option 3: Bolster Medicaid access across existing practices
Finally, medical groups will likely find that even if they use the above options, geographic realities, patient preferences, or other market-specific factors mean they are still treating at least some Medicaid patients within their existing physician practices. To ease access difficulties in doing so, some medical groups choose to mandate minimum Medicaid panel sizes for PCPs. Taking steps to reduce no-show rates is also particularly important for this population.
May 8 webconference: Build the foundational Medicaid network
Learn how to address avoidable, low-margin utilization flashpoints to build the foundation for more transformational change in the future.