Avital Ludomirsky and coauthors assess the level of Medicaid participation among physicians listed in the provider network directories of managed care plans.

Medicaid services have been increasingly outsourced by states to private managed care plans.

Ludomirsky and coauthors examine data from four states across the period 2015–17 and determined more than a third of the physicians listed in provider network directories for the plans treated ten or fewer Medicaid beneficiaries in a year.

The authors provide policy suggestions based on their findings that would improve the oversight of provider networks in state Medicaid programs.

The authors state that relying on the physicians listed in Medicaid managed care network directories to measure access is insufficient.

Instead, the authors suggest that enforcement of network adequacy standards should evolve to ensure that plan networks are evaluated on the basis of whether they include physicians who are both valued by Medicaid beneficiaries and willing to treat them.

Ludomirsky will discuss this paper in greater detail at the next Health Affairs event on May 17. Register today.

Today in Health Affairs Forefront, Karen Joynt Maddox and Kenton Johnston discuss quality improvement efforts that incorporate equity as a key priority.

The authors indicate that Medicare beneficiaries who are also eligible for Medicaid (dual eligibles) have less access to high-quality care and are more likely to have a disability.

Given these factors, the authors suggest that measuring cost and quality of care is a critical step in determining payment models to improve equity.

This article is the latest among a series in response to the latest developments in policy and research affecting the dual-eligible population. Other authors will contribute to the series as well.

The series is produced with the support of Arnold Ventures. Included articles are reviewed and edited by Health Affairs Forefront staff; the opinions expressed are those of the authors.

The series will run through August 30, 2022; submissions are accepted on a rolling basis.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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