To evaluate the influence of NC Medicaid Managed Care on primary care and obstetrics/gynecology (Ob/Gyn) practices that contract with NC Medicaid, the North Carolina Provider Experience Survey was developed and administered across all North Carolina primary care practices or their corporate parent.
This report describes findings from the second assessment of provider experience and satisfaction with the NC Medicaid program, which was conducted April to June 2022. This year’s report represents providers’ experiences with the Prepaid Health Plans (PHPs) in the first year of NC Medicaid Managed Care and allows for comparisons against last year’s pre-managed care, fee-for-service baseline.
Providers were asked about contracting with PHPs, the overall perceived effect of PHPs on care delivery, and their experience with PHPs on clinical and administrative factors. The survey also asked providers about their approach to integrating behavioral health care and their plans regarding contracting with Tailored Plans.
Stratified analyses were conducted to draw comparisons between rural and non-rural provider groups; small, medium and large provider groups; and groups delivering obstetrics and gynecology versus those who only provide primary care.
The survey was implemented by the Sheps Center for Health Services Research. The full report and two-page summary are available on the NC Medicaid Quality Management and Improvement webpage.
Key Findings
- All five PHPs had high rates of contracting with providers. Rates of contracting with each of the PHPs ranged from 73.3% to 94.5%, and provider organizations contracted with an average of 4.3 plans.
- There were small but meaningful differences in provider experience with PHPs compared with provider experience with NC Medicaid Direct prior to the transition:
- PHPs performed better than NC Medicaid Direct on access to behavioral health prescribers and therapists. Despite this, for a second year in a row, access to behavioral health providers was rated substantially lower than all other domains.
- PHPs performed worse than NC Medicaid Direct on timely claims processing and overall provider relations.
- There were not meaningful differences between PHPs on performance domains. Providers rated their experience with PHPs on administrative factors (e.g., claims processing) slightly better than clinical factors (e.g., network adequacy).
- Large provider organizations rated their experience with PHPs worse than smaller provider organizations. There was no difference in experience between rural and non-rural providers.
Summary
Overall, PHPs performed similarly to NC Medicaid Direct when comparing provider experiences to the baseline survey performed prior to the launch of Standard Plans. PHPs have established an Administrative Simplification Workgroup that aims to improve providers’ experience with managed care.
Additional investigation of issues and opportunities for improvement will be carried out with other data collection methods under the waiver evaluation and will include focus groups, interviews, claims and other clinical and administrative data analyses. For more information about quality improvement, please see the NC Medicaid Quality Management and Improvement webpage.
Contact
NC Medicaid Contact Center: 888-245-0179