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Member Loyalty Reassignment

Date: 09/08/25

MHS will now be reviewing Medicaid Primary Medical Provider (PMP) assignments to proactively assign members to providers based on loyalty. Member PMP assignments will be reviewed quarterly to closely align with where members are seeking care, provider availability, and appropriate proximity criteria.

Member assignments for PMPs will be based off claims data using the criteria below:

  • No visits to the members assigned PMP.
  • No claims on file.
  • If we have a record of a member seeking care from another PMP other than to whom they are assigned to. This will be determined by three or more visits with another PMP.

This proactive strategy will render benefits for both the members and PMPs.

  • Improved Patient-Physician Relationship: Loyalty-based re-assignment can strengthen the bond between patients and their PMPs, leading to better communication, trust, and satisfaction.
  • Better Continuity of Care: Patients with long-term relationships with their PMPs are more likely to receive consistent and coordinated care, which can improve health outcomes and reduce medical errors.
  • Enhanced Patient Engagement: Loyal patients are often more engaged in their healthcare, adhering to treatment plans, attending regular checkups, and participating in preventive care activities.
  • Personalized Care: PMPs who have long-term relationships with their patients can provide better personalized care, as they have a deeper understanding of their patients' medical histories, preferences, and social determinants of health.
  • Higher Patient Satisfaction: Patients who feel a sense of loyalty and connection with their PMPs are generally more satisfied with their care, which can lead to better overall patient experience and retention.
  • Improved Health Outcomes: Continuity and personalized care associated with patient loyalty can lead to better management of chronic conditions, early detection of health issues, and improved overall health outcomes.
  • Reduced Healthcare Costs: Effective management of chronic diseases and preventive care through loyal PMP-patient relationships can lead to fewer hospitalizations, emergency room visits, and unnecessary medical tests, reducing healthcare costs.
  • Increased Practice Efficiency: PMPs who have long-term relationships with their patients can work efficiently, as they are familiar with their patients' medical histories and needs, reducing the time spent on redundant assessments and paperwork.
  • Stronger Preventive Care: Loyal patients are more likely to participate in preventive care measures recommended by their PMPs, leading to early detection and prevention of diseases.
  • Higher Provider Job Satisfaction: PMPs who have established loyal relationships with their patients often experience higher job satisfaction due to the trust and rapport they build with their patients.
  • Patient Retention: Loyalty-based re-assignment can enhance patient retention rates, as satisfied patients are more likely to stay with their PMP and health plan.
  • Data Insights: Long-term relationships provide a wealth of data that can be used to tailor healthcare services and interventions more effectively, improving the overall quality of care.

Reassigning members to PMPs based on loyalty can create a patient-centered healthcare environment, fostering trust, improving outcomes, and enhancing the overall healthcare experience for patients and providers alike.



Last Updated: 09/11/2025