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.