LAUSR

The importance of independent primary care practices as North Carolina approaches Medicaid transformation cannot be overstated. Forty-four percent of the state's pediatricians remain in independent practice and more than a quarter of family physicians maintain an equity stake in their practice, with a higher percentage working in or owning an independent practice (internal data, survey of members of the NC Academy of Family Physicians and the NC Pediatric Society, April 2019). As a result, it is crucial to consider how independent practices will be impacted by Medicaid transformation and the overall movement to value-based health care. To be successful, Medicaid must work for all primary care practices regardless of their size or ownership structure. Today, almost all the state's pediatricians and 90% of the state's family physicians care for Medicaid patients, one of the highest participation rates in the country (internal data, survey of members of the NC Academy of Family Physicians and the NC Pediatric Society, April 2019). Nationally, only about 68% of family physicians accept new Medicaid patients [1] and participation rates are even lower in some states that adopted the managed care delivery models earlier. What Can We Learn From States That Have Already Moved to Managed Care? In 2016, Sarah H. Gordon and colleagues conducted a qualitative review of primary care physicians treating Medicaid managed care patients in a Northeastern state. The authors noted a few key issues, including inadequate investment in primary care and the need to address the social determinants of health of Medicaid…