573 - Attitudes of Pediatric Primary Care Practices towards Medicaid Payment Reform

Poster Number: 573
Publication Number: 573.222

Charanya Uppalapati, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Alex H. Krist, Virginia Commonwealth University, Fairfax, VA, United States; Benjamin Webel, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Elizabeth Wolf, Virginia Commonwealth University School of Medicine, Richmond, VA, United States

Background: Most publicly insured children in Virginia receive care through large, safety net health systems. Smaller practices are often unable to accept Medicaid because of low fee-for-service reimbursement rates. It is not yet known how additional value-based payments would improve the ability of pediatric primary care practices to accept publicly insured children.

Objective: To determine the attitudes of pediatric primary care practices to value-based payments from Medicaid.

Design/Methods: As part of a larger study evaluating the impact of Medicaid expansion and payment reform, we conducted a convenience sample of pediatric primary care practices in Virginia through the Virginia chapter of the American Academy of Pediatrics, the Virginia chapter of the American College of Physicians and the Medical Society of Virginia listservs. REDCap surveys were emailed to every known pediatric primary care practice in Virginia between 7/21/21 and 4/12/22. Descriptive statistics were tabulated.

Results: We received completed surveys from 81 pediatric primary care practices across the state (29% response rate). When queried what changes they would make if their practices received additional alternative value-based payments, 90% said they would hire new staff including care coordinators, care managers or patient navigators (57%), mental health providers (53%), and social workers (44%). Most practices (68%) reported that they would increase care management activities. Goals of practice change were improving access to care, improving the practice’s financial viability, reducing negative care events and ensuring that their patients get recommended care. Fifty-nine percent said they would make changes to reduce clinician burnout. Thirty percent reported that they would increase the number of Medicaid patients in their practice. Practices reported that they would be more encouraged to see Medicaid patients if there were improved access to mental health providers (84%) and patient navigators (65%).

Conclusion(s): We found that value-based payments would encourage a third of pediatric primary care practices to accept more Medicaid patients and most practices said they would make changes to improve how they provide care. Primary care practices requested care coordinator support and improved mental health access to help them care for publicly insured patients. Value-based payments may be an important part of increasing access for publicly insured patients especially in areas that are not serviced by large safety net health systems.