Challenges faced by Medicaid managed care coordinators working with members with substance use disorder.

Abstract

Objectives: Medicaid managed care organization (MCO) care coordinators play a crucial role in assisting high-need Medicaid members with substance use disorder (SUD) and facilitating their connections with medical and social services. This study assessed challenges faced by care coordinators serving patients with SUD, including the types and frequencies of barriers, associated care coordinator and patient factors, and their relationship with burnout and job satisfaction.

Study design: Web-based survey data from 322 Virginia Medicaid MCO care coordinators.

Methods: Coordinators rated 15 barriers related to providing services to patients with SUD. Principal components analysis (PCA) identified 3 subscales categorizing these challenges (challenges accessing resources, administrative and regulatory burden, and data integration). Multivariable linear regression explored associations between coordinator and patient factors and subscales for categories of barriers. Pearson correlations were used to examine the relationship between these barriers and job satisfaction.

Results: Coordinators reported a high frequency of challenges in many care coordinating activities: Between 49% and 82% reported each barrier as "somewhat" of a problem or a "major" problem. Using PCA, 3 main categories of barriers were identified. Having a high proportion of patients with SUD was associated with greater difficulties in accessing resources (P < .01) and data integration issues (P < .05), and working for specific MCOs was associated with all 3 categories of barriers (P < .05). Job satisfaction and burnout were correlated with all 3 categories as well and were most strongly associated with administrative and regulatory burden.

Conclusions: Care coordinators face multiple challenges serving Medicaid members, particularly those with SUD. State-level Medicaid policies supporting care coordinators may help.