Design of enhanced primary care case management programs operating in rural communities: Lessons learned from 3 states

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Executive summary

States are beginning to develop alternative managed care strategies for their Medicaid populations, including enhanced primary care case management (PCCM) programs that incorporate features originally developed for fully capitated managed care programs, such as care coordination and quality improvement efforts. Such alternative approaches have proven to be especially useful in rural communities, where it is more difficult to attract and maintain fully capitated managed care contracts. This findings brief highlights lessons learned from three states: Florida, North Carolina and Oklahoma, which provide enhanced benefits to Medicaid beneficiaries.1 We find that:

• Recipients in more isolated communities seem to benefit greatly from the additional clinicians and individualized care associated with case and disease management programs.
• Face-to-face care management is more difficult to implement and maintain in rural areas because of the geographic dispersion of enrollees and the limited number of recipients in a given service area, causing increased use of management by telephone. Disease management programs that rely on telephone case management are problematic, as some Medicaid recipients do not have consistent access to telephones.
• Rural care managers may have more responsibilities due to the lack of other available community resources to provide patient education or address psychosocial problems. Partially capitated systems can ensure the viability of rural primary care providers by guaranteeing a stream of revenue with minimal financial risk.