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Building and Sustaining Physician Networks in Medi-Cal Managed Care and Healthy Families

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Abstract:

Physician participation in Medi-Cal has been a problematic issue, as this June 2003 report illustrates. A 1999 statewide survey of Medi-Cal beneficiaries showed 56% reported difficulty finding physicians willing to see them and a 1998 survey of California physicians found that nearly half of all physicians do not accept Medi-Cal patients. Low participation levels mean that even though Medi-Cal and Healthy Families participants may be able to afford care because their coverage eliminates the price barrier, they still might not be able to get care from their physicians of choice, to receive the care in a timely manner, or to access care at all. Less understood is how participation issues arise and how important they are, not only in Medi-Cal, but also in the Healthy Families Program. Managed care health plans--which establish and maintain physician networks--are uniquely positioned to provide information on physician participation and the pressure points for change. In spring 2002, Mathematica Policy Research conducted a telephone survey of all health plans and look-alikes participating in Medi-Cal and Healthy Families about their experiences developing and sustaining physician networks, the nature of any access problems, and what can be done to remedy these problems. Of the 35 health plans in the sample, 33 completed the survey, representing 94% of Medi-Cal managed care enrollment and 99% of Healthy Families enrollees. Health plans said these problems stem from two key factors: (1) undersupply and (2) unwillingness to participate. This report details the survey methods, results, and policy implications for improving access to physicians in Medi-Cal managed care and Healthy Families.