Overcoming Obstacles to Specialty Care for Medicaid Patients

Strategies Include Bringing Specialty Care to Primary Care Settings, Training Primary Care Clinicians to Provide Specialty Care, and Improving Communication Across Care Settings

Media Advisory
June 7, 2013

Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Across the country, several innovative approaches to expanding Medicaid patients’ access to specialty care are showing early promise, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the Commonwealth Fund.

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 models—in Connecticut, Illinois, Minnesota, New Mexico, Oregon, and Tennessee—that 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 report—Improving Access to Specialty Care for Medicaid Patients: Policy Issues and Options—available online here.

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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.