Findings on Managed Care Reported by Investigators at Yale University (In Medicaid Managed Care Networks, Care Is Highly Concentrated Among a Small Percentage of Physicians): Managed Care

2022 JUN 23 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Researchers detail new data in Managed Care. According to news reporting from New Haven, Connecticut, by NewsRx journalists, research stated, “States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access to care, many states set network adequacy standards that require plans to contract with a minimum number of physicians.”

Financial supporters for this research include Yale National Clinician Scholars Program, National Center for Advancing Translational Science, a component of the National Institutes of Health (NIH), Centers for Medicare and Medicaid Services, NIH National Heart Lung & Blood Institute (NHLBI), Yale University from Johnson Johnson, Medical Device Innovation Consortium, National Evaluation System for Health Technology, Food and Drug Administration for the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation program, Agency for Healthcare Research & Quality, Arnold Ventures.

The news correspondents obtained a quote from the research from Yale University, “In this study we used data from the period 2015-17 for four states to assess the level of Medicaid participation among physicians listed in the provider network directories of each managed care plan. We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year. Care was highly concentrated: 25 percent of primary care physicians provided 86 percent of the care, and 25 percent of specialists, on average, provided 75 percent of the care.”

According to the news reporters, the research concluded: “Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries’ preferences and physicians’ willingness to serve Medicaid patients.”

This research has been peer-reviewed.

For more information on this research see: In Medicaid Managed Care Networks, Care Is Highly Concentrated Among a Small Percentage of Physicians. Health Affairs, 2022;41(5):760-768. Health Affairs can be contacted at: Project Hope, 7500 Old Georgetown Rd, Ste 600, Bethesda, MD 20814-6133, USA.

Our news journalists report that additional information may be obtained by contacting Avital B. Ludomirsky, Yale University, New Haven, CT 06520, United States. Additional authors for this research include Jacob Wallace, Anthony Lollo, Susannah Bernheim, Joseph S. Ross, Chima D. Ndumele and William L. Schpero.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1377/hlthaff.2021.01747. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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