Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 1. Satisfaction Measures Developed for the Case Studies

01/01/2002

Members’ reports of their satisfaction with the managed care plan are increasingly used to assess plan quality (National Committee for Quality Assurance 1999; Cleary and McNeil 1988; and Donabedian 1985). While there are other important measures, satisfaction is useful because it captures a person’s assessment of the net benefits and costs of the plan. It can also be measured straightforwardly in surveys and does not require collection of clinical information.

We measured overall satisfaction by asking seniors whether they would recommend their MCO to another person with the same conditions (Table V.3). We also measured key components of satisfaction with the MCO network and policies. In particular, we asked about satisfaction with the choice of provider, as the lack of provider choice may be problematic for seniors who have chronic conditions or disabilities that require specialized care. We also included measures of the seniors’ confidence that the MCO would provide needed services, as well as of their satisfaction with out-of-pocket costs for medical care.

We also looked at satisfaction with health care providers, including questions about access and the perceived quality of physician care. We included measures of access to the primary care physician, specialist physicians, as well as therapists, because high-risk seniors are likely to see a multitude of providers. Asking only about access to a primary care physician might miss important information about high-risk seniors’ experience accessing care. Our measures of perceived quality of physician care include frequency of receiving needed tests and treatments. We also include physician-patient communication, such as satisfaction that the physician explained tests results, treatments, and medications. Physician-patient communication is an important measure of perceived quality for high-risk seniors, as many have chronic problems that require self-treatment regimens and numerous medications. For example, better communication would help ensure that patients and caregivers are sufficiently educated and mindful of the contraindications of their prescriptions.

In addition to questions about satisfaction, we asked the seniors an open-ended question about what they would do if they were dissatisfied with medical care or a service coverage decision. In particular, we identify those high-risk seniors who do not give any concrete action they would take in these instances. Such seniors are of concern because they may be unable to advocate effectively for themselves if they believe their care to be inadequate. As with the seniors who reported not having sufficient information to choose the plan best suited for them, those seniors who do not know how to make their complaints heard represent a potential target for policymakers and plan administrators interested in making managed care work better.

When analyzing differences in member satisfaction among the three MCOs, we control for differences in the characteristics of the seniors enrolled in each organization (Table II.4). We could not control, however, for differences in the practice patterns either in the three sites or in the benefit packages offered by the MCOs. Thus, the satisfaction differences among MCOs may not be due solely to differences in their operations.

TABLE V.3. Satisfaction Measures
OVERALL SATISFACTION
Would Recommend the MCO to Another Person with Similar Health Condition  
SATISFACTION WITH COSTS
Amount of Out-of-Pocket Costs for Medical Care
   Very satisfied
   Somewhat satisfied
   Somewhat dissatisfied
   Very dissatisfied
Plan Will Pay for Needed Health Care
   Very satisfied
   Somewhat satisfied
   Somewhat dissatisfied
   Very dissatisfied
SATISFACTION WITH PROVIDERS
Satisfied with Location of Physician’s Office
Level of Satisfaction That Can See Primary Care Physician When Wants to
   Very satisfied
   Somewhat satisfied
   Somewhat dissatisfied
   Very dissatisfied
Amount of Choice with Health Care Providers
   Very satisfied
   Somewhat satisfied
   Somewhat dissatisfied
   Very dissatisfied
Had Difficulty Seeing Specialist When Wanted to See One
Had Difficulty Seeing Therapist
Frequency Primary Care Physicians Spent Enough Time with Plan Member
   Never
   Sometimes
   Usually
   Always
Frequency Member Thought Got Needed Tests or Treatments
   Never
   Sometimes
   Usually
   Always
Frequency Member Involved as Much as Wanted in Care Decision
    Never
   Sometimes
   Usually
   Always
Frequency Satisfied with Explanations of Test Results, Medications, and Other Treatments  
   Never
   Sometimes
   Usually
   Always
MCO = managed care organization.

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