Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 1. The Case-Study MCOs Differed in the People They Enrolled in Care Management


The populations enrolled in care management differ systematically between Keystone East and the other two organizations, Aspen and Kaiser Colorado. Based on an analysis of the characteristics of the seniors included in our care management sample (who were identified from care management enrollment lists provided by the MCOs), we found different rates of enrollment among the organizations. Keystone East enrolled approximately five percent of its Medicare enrollees into its care management program, while the other two organizations enrolled less than three percent (Table V.13). This differential targeting is seen in the characteristics, health, and functioning levels of the seniors enrolled in care management at the three organizations. In particular, we noted the following substantial differences:

  • Seniors in care management at Keystone East are, on average, younger, more likely to be a racial/ethnic minority, less educated, and less likely to live alone than the seniors in care management at the other organizations.

  • Seniors in care management at Kaiser Colorado were more likely to have functional limitations than care-managed seniors at the other organizations.

  • Among the Kaiser Colorado care management sample, 20 percent had dementia or related impairments. This is more than twice the fraction in the care management samples at the other organizations.

TABLE V.13. Enrollment in Care Management at the Case-Study MCOs
    Aspen Medical  
  Kaiser Health Plan  
of Colorado
  Keystone East  
Health Plan
Medicare + Choice Population 13,000 38,400 102,000
Beneficiaries for Whom Care Management Was Availablea   13,000 11,000 102,000
Beneficiaries Enrolled in Care Managementb 272 360 5,070
Fraction of Beneficiaries Enrolled in Care Management 2.1 3.3 5.0
SOURCE: Information collected during the site visits and from the lists of members in care management supplied by the three MCOs (Stapulonis et al. 2001).
  1. At the time of our site visit, Kaiser Colorado provided care management in only two clinics.
  2. The figures shown are the number of seniors included on the lists of seniors in care management that were supplied by each MCO. Some of the seniors on the list may no longer have been receiving active care management services. Stapulonis et al. (2001) provide details of the specific time periods covered by the care management lists.

Because of these differences, we make comparisons only among the three MCOs on the basis of regression-adjusted means. This is the same method used throughout this report for comparing MCOs. It provides estimates that describe the care management programs as if all MCOs served seniors with the same characteristics (see Table II.6 for a list of the characteristics for which the regression controls).

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