Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 1. Demographic Characteristics


The high-risk seniors in our sample are more likely than the average Medicare beneficiary to be of advanced age, female, and white. Chronic conditions, disability, and frailty are all more common among those of advanced age (Health Care Financing Administration 1999), so it is not surprising that Table II.4 indicates that our sample of high-risk seniors is older than the average Medicare beneficiary. While the high percentage of seniors of advanced age (70 percent) is due primarily to our sample selection process, 17 percent are age 85 and older even among our subsample of seniors in care management, or seniors with a recent hip fracture or stroke. The fact that this disproportionately aged sample is predominately female is likely due to females’ longer life expectancy. White non-Hispanics constitute 76 percent of our sample, significantly lower than the 85 percent of all Medicare beneficiaries. While this may be surprising because of the large proportion of white non-Hispanics in Denver and Minneapolis-St. Paul, 72 percent of the weighted sample consists of seniors in Keystone East, which reflects the larger-than-average proportion of black non-Hispanics in Philadelphia.

Our sample is also characterized by relatively low education and income levels compared with the general elderly Medicare population. Table II.4 indicates that nearly half (46 percent) of the seniors in our sample did not complete high school, and this is significantly higher than the 37 percent for Medicare beneficiaries. Low educational attainment, to the extent that it is associated with low levels of literacy, may impede seniors’ ability to understand written instructions and thus complicate the provider’s job of communicating treatment protocols. A larger proportion of seniors in our sample, 35 percent compared to 30 percent for the Medicare population (as indicated in Table II.4), have annual incomes below $10,000. A disproportionately low-income population may face additional challenges to obtaining effective care as a result of their severely limited ability to purchase services not covered by Medicare.

TABLE II.4. Demographic Characteristics
(Percentages and Their Standard Errors)
    Survey Sample     All Medicare Seniors  
Age at Time of Interview
   65 to 74 15.8^ (0.6) 52.5
   75 to 84 14.2^ (0.6) 34.9
   85 or older 70.0^ (0.2) 12.7
   Female 66.4^ (1.6) 58.2
   Male 33.6^ (1.6) 41.8
   White (non-Hispanic) 75.6^ (1.5) 84.5
   Black (non-Hispanic) 11.4^ (1.1) 7.5
   Hispanic 3.6^ (0.6) 5.8
   Other 9.4^ (1.0) 2.2
   Did not complete high school   46.0^ (1.7) 36.8
   High school graduate 33.9 (1.6) 32.5
   At least some college 20.1^ (1.2) 30.8
Total Household Income
   Less than $10,000 35.3**^ (1.9) 30.2
   $10,000 to less than $20,000 40.1**^ (1.9) 29.5
   $20,000 or more 24.6**^ (1.5) 40.3
Lives Alone 41.5^ (1.7) 29.5
Residential Situation
   Lives in a community 82.8^ (1.3) 94.1
   Lives in a Nursing Home 17.2 5.9
SOURCE: Telephone survey of 1,657 high-risk seniors from three managed care organizations, conducted between March and December 1999 by MPR.
NOTE: Values are percentages, with standard errors in parentheses.
  1. Data from 1997 Medicare Current Beneficiary Survey (MCBS) for Medicare beneficiaries age 65 and over.

^ Significantly different from MCBS mean. Standard errors not available for MCBS means, so survey sample means considered significantly different from MCBS if difference is greater than 2 x (standard error) of the survey sample mean.
** Item had over 20 percent nonresponse. No other variables in this table had more than 5 percent nonresponse.

The high-risk seniors in our sample live in a mix of residential settings. Most of them, 83 percent, lived in the community, but 17 percent lived in nursing homes at the time we interviewed them. This rate of institutionalization is higher than among all Medicare seniors, although it is not surprising, since our sample has a greater incidence of functional limitations and multiple chronic conditions. Among community-resident seniors, those who live alone face higher risks because there is no one else in the household to provide assistance with ADLs or IADLs should such assistance be necessary. In the absence of a resident caregiver, the responsibility of arranging and paying for these services typically rests with the senior or other nonresident family members.

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