Member and Provider Services Unit: Provider Member Relations

Access to Care: # of primary care providers (PCPs) per 1500 Medicaid members

7.52Oct 2020

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Notes on Methodology

The target for this measure is 1 primary care provider per 1500 members per county in Vermont.

                                   
  Access to Care:  # of Primary Care Providers (PCPs) per 1500 Medicaid Members   
    SFY20 SFY21  
  Jun-20 Jul-20 Aug-20 Sep-20 Oct-20  
  County #
Medicaid Members
# PCP # PCP
per 1500 members
#
Medicaid Members
# PCP # PCP
per 1500 members
#
Medicaid Members
# PCP # PCP
per 1500 members
#
Medicaid Members
# PCP # PCP
per 1500 members
#
Medicaid Members
# PCP # PCP
per 1500 members
 
  Addison 8473 39 6.90 8622 39.00 6.78 8718 39.00 6.71 8806.00 39.00 6.64 8877 40 6.76  
  Bennington 12228 77 9.45 12368 77.00 9.34 12431 77.00 9.29 12562.00 77.00 9.19 12610 77 9.16  
  Caledonia 10685 63 8.84 10773 62.00 8.63 10829 63.00 8.73 10954.00 63.00 8.63 10972 63 8.61  
  Chittenden 32409 209 9.67 32888 211.00 9.62 33193 211.00 9.54 33700.00 211.00 9.39 34010 211 9.31  
  Essex 2317 10 6.47 2332 11.00 7.08 2347 11.00 7.03 2356.00 11.00 7.00 2390 11 6.90  
  Franklin 14535 38 3.92 14643 37.00 3.79 14754 37.00 3.76 14933.00 37.00 3.72 14999 37 3.70  
  Grand Isle 1871 6 4.81 1884 6.00 4.78 1896 6.00 4.75 1921.00 6.00 4.69 1932 6 4.66  
  Lamoille 7425 26 5.25 7549 27.00 5.36 7605 27.00 5.33 7708.00 27.00 5.25 7760 28 5.41  
  Orange 8167 130 23.88 8249 130.00 23.64 8309 130.00 23.47 8443.00 130.00 23.10 8504 130 22.93  
  Orleans 11181 18 2.41 11295 18.00 2.39 11370 18.00 2.37 11482.00 17.00 2.22 11566 17 2.20  
  Rutland 18894 52 4.13 19141 52.00 4.08 19280 53.00 4.12 19500.00 53.00 4.08 19658 52 3.97  
  Washington 14993 69 6.90 15196 69.00 6.81 15323 71.00 6.95 15511.00 71.00 6.87 15569 71 6.84  
  Windham 12706 104 12.28 12867 104.00 12.12 12981 103.00 11.90 13199.00 103.00 11.71 13291 103 11.62  
  Windsor 17022 56 4.93 17205 56.00 4.88 17318 56.00 4.85 17533.00 57.00 4.88 17691 56 4.75  
  Total 172,906 897 7.78 175,012 899 7.71 176,354 902 7.67 178,608 902 7.58 179,829 902 7.52  
                                   
Partners
  • DVHA Data Unit
  • Provider Community
  • DVHA Clinical Unit
  • Vermont Department of Health
  • DXC
Story Behind the Curve

Vermont is experiencing a physician shortage in key specialty areas. DVHA has chosen to monitor 5 key groups with dwindling provider counts in order to work with multiple agencies to address issues proactively: behavior and mental health and substance abuse providers, cardiologists, dentists, pharmacies, and primary care providers (PCPs).

Primary Care Providers:

Primary Care is big issue in Vermont. Many states across the country have a need to attract more primary care physicians, but Vermont's situation has an additional twist: a sizeable number of the state's primary care doctors are expected to retire in the next few years. To maintain the status quo, Vermont will require an additional 119 primary care physicians by 2030, a 19% increase of the state’s current (as of 2010) 606 practicing PCPs. The current population to PCP ratio of 1076:1 is lower than the national average of 1463:1. The 2030 projection stands above the Northeast overall and below the nation overall. Components of Vermont’s increased need for PCPs include 48% (58 PCPs) from increased utilization due to aging, 46% (55 PCPs) due to population growth, and 5% (6 PCPs) due to a greater insured population following the Affordable Care Act (ACA). 

Due to member complaints regarding lack of PCP’s in Vermont, as well as the aging population of PCP’s, it is important to monitor the PCP population in each county in Vermont. Almost 30 percent of primary care doctors in the state of Vermont are over the age of 60 or nearing retirement age. When they retire, there likely will not be enough new primary care doctors to replace them. When a physician shortage occurs, patients are unable to access the care they need. They might have trouble finding a physician to book an appointment with, or once an appointment is obtained patients might face long office wait times. These issues adversely impact patient satisfaction and can also have negative health consequences.

PMR monitors this measure in collaboration with the Vermont Department of Health: https://www.healthvermont.gov/systems/health-professionals/shortages-and-designations

Our benchmark is 1 PCP per 1500 Medicaid members.

Last updated: 10/15/2020

Strategy

In collaboration with VDH, PMR is:

  • Sending surveys to assess wait times
  • Engaging with PCPs who are no longer accepting new (?) patients to better understand why and to encourage them to see more Medicaid members
  • Engaging with PCPs who accept Vermont Medicaid members but have low claim volume to understand why and to encourage them to provide more services to Medicaid members

Potential other solutions include:

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy