The Impact of Payment Reform on Medicaid Access and Quality: A National Survey of Physicians.

Introduction: Addressing health inequity should involve improving access and quality of care for individuals with low income. In the United States, programs that involve accountable care incentives and broader risk adjustment are poised to help address these issues. However, there is limited understanding of perspectives among physicians as key stakeholders in determining access and quality.

Methods: The authors surveyed physicians about how they perceived accountable care incentives and broader risk adjustment (greater inclusion of clinical, social, and behavioral risk factors) would impact access and quality for patients with low income insured through Medicaid.

Results: Low Medicaid reimbursement rates and inadequate adjustment for patients' clinical, social, and behavioral risk factors were major factors why physicians reported not seeing Medicaid patients in their clinical practices. Many physicians believed that accountable care incentives and changes in risk adjustment would help facilitate higher quality of care for Medicaid patients, while the minority of physicians believed that accountable care organizations could ultimately improve the value of care beyond managed care organizations.

Discussion: Policymakers could incorporate behavioral, social, and equity-related factors into risk adjustment and consider ways to incorporate accountable care incentives into existing and new entities in Medicaid.

Conclusion: The majority of physicians believed that the care of Medicaid patients would improve under accountable care incentives and broader risk adjustment. Understanding physician perspectives is important for contextualizing policy about how payment reforms could affect access and quality of care for Medicaid patients.