Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 1. Types of High-Risk Seniors with Multiple Impairments

01/01/2002

Different impairments have different implications for care delivery. For example, physical impairments can often make it difficult for a senior to travel to receive care. Mental impairments can limit the extent to which a senior can engage in self-monitoring or self-care. To assess how impairments affected care for the high-risk seniors in our sample, we used the survey data to define three overlapping groups of seniors:13

  • Seniors with Physical Impairments. We considered a sample member to have a physical impairment if he or she has at least one of the following: any ADL limitation, hardening of the arteries, a previous heart attack, other heart disease, a previous stroke or hip fracture, cancer, diabetes, arthritis, asthma or other respiratory disease, or osteoporosis.

  • Seniors with Mental Impairments. We considered as having a mental impairment any sample member who reported depression, Alzheimer’s disease or other dementia, or a prior stroke.

  • Seniors with Chronic Conditions. We considered as having a chronic condition any sample member who reported having at least one of the following 11 illnesses that we asked about in the survey: hardening of the arteries, hypertension, a previous heart attack, other heart disease, depression, cancer, diabetes, arthritis, asthma or other respiratory disease, or Alzheimer’s disease or other dementia.

While there is considerable variation among each of these groups, they highlight three different types of challenges for MCOs. Table III.4 illustrates the distribution of these three impairment groups and a fourth group that includes those people who report no impairments or chronic conditions. Among our interview sample, 87 percent report some sort of physical impairment, and about the same percentage report having a chronic condition. Just over a quarter of the community-resident seniors in our sample reported a mental impairment. Looking at the overlap among these groups, we note that approximately a quarter (26.5 percent) of the sample reported having both a physical and a mental impairment, as well as a chronic condition; only 9 percent of the sample reported no impairment or chronic condition.

TABLE III.4. Impairments and Chronic Conditions among Our Sample of High-Risk Seniorsa
(Percentages and Their Standard Errors)
    Survey Sample  
Impairment Groups
   Seniors with physical impairments 87.0 (1.3)
   Seniors with mental impairments 28.3 (1.6)
   Seniors with chronic conditions 88.5 (1.3)
   Seniors without impairments or chronic conditions 8.7 (1.1)
Impairment Combinations
   Seniors with physical and mental impairments 27.5 (1.6)
   Seniors with physical impairments and chronic conditions 84.3 (1.4)
   Seniors with mental impairments and chronic conditions 27.2 (1.6)
   Seniors with physical and mental impairments and chronic conditions   26.5 (1.5)
Number of Observations 1,399
SOURCE: Sample of 1,399 community residents take from 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 and are weighted to represent the population and correct for nonresponse. Standard errors are in parentheses. None of the variables used in this table had more than a 5 percent response rate.
  1. A person with at least one of the following is defined as physically impaired: any ADL limitation, hardening of the arteries, a previous heart attack, other heart disease, previous stroke, depression, cancer, diabetes, arthritis, asthma, previous hip fracture, or osteoporosis. A mental impairment involves the presence of one or more of the following: a previous stroke, depression, or Alzheimer’s or other dementia. A person with at least one of the following is defined as having a chronic condition: hardening of the arteries, hypertension, a previous heart attack, other heart disease, depression, cancer, diabetes, arthritis, asthma or other respiratory disease, or Alzheimer’s or other dementia.

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