Department of Health
Preferred Primary Care Provider
Program To improve the health care provided to underserved populations
in New York's Medicaid program, in 1990 the State Legislature created the Preferred Primary
Care Provider Program, which is administered by the Department of Health. In this program,
primary care providers offer services in underserved areas, and in return may be paid
according to different reimbursement methodologies and are exempt from certain restrictions
on their services. We examined certain aspects of the program and found that, even though it
has been in operation for more than five years, Department officials have not evaluated its
performance against its established goals. As a result, Department officials do not know
whether access to health care has improved for Medicaid recipients, the quality of health care
has improved for Medicaid recipients, or the cost of health care is better controlled in the
Medicaid program. We also found that, because program costs are not summarized,
Department officials cannot evaluate whether the program is cost-effective. We further found
that the Department does not adequately monitor the medical services provided through the
program. We note that Department officials expect preferred providers to be absorbed into
managed care programs for Medicaid recipients. We believe the improvements we
recommend should be applied to these managed care programs.
For a complete copy of 95-S-118 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.