Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 2. Health and Functioning


Not surprisingly, beneficiaries in our sample have inferior health status and are more functionally limited than the average Medicare-covered senior (Table II.5). Just over 30 percent of high-risk seniors in our sample consider themselves in excellent or very good health compared with 44 percent of all Medicare-covered seniors.

TABLE II.5. Health and Functioning
(Percentages and Their Standard Errors)
    Survey Sample     All Medicare Seniorsa  
Health Assessment
   Excellent or very good   30.2^ (1.6) 43.8
   Good 32.7 (1.6) 30.7
   Fair 25.7^ (1.5) 18.3
   Poor 11.4^ (1.1) 7.2
Functional Limitationsb
   None 42.4^ (1.8) 62.8
   IADLs only 30.2^ (1.7) 17.5
   1 to 2 ADLS 18.4^ (1.4) 12.7
   3 to 5 ADLs 8.9 (1.0) 7.1
Number of Chronic Conditionsc
   None 9.0 (1.1)  
   One or two 40.8(1.7)  
   Three or four 35.6 (1.6)  
   Five or more 14.6 (1.1)  
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. None of the variables in this table had more than 5 percent nonresponse.
  1. Data from 1997 Medicare Current Beneficiary Survey (MCBS) for Medicare beneficiaries age 65 and over.
  2. Functional limitations involve needing help or supervision with (1) activities of daily living (ADLs) that include bathing, eating, dressing, transferring, and toileting; or (2) with Instrumental Activities of Daily Living (IADLs) that include preparing meals, doing light housework, managing money, or using the telephone. These questions asked only of the 1,399 community residents in our sample.
  3. People were asked whether they had been diagnosed with any of the following 12 chronic conditions: arteriosclerosis, hypertension, heart attack, other heart disease, previous stroke, depression, cancer, diabetes, arthritis, asthma, previous hip fracture, and Alzheimer’s or other dementia. Figures for all Medicare seniors are not presented, because the MCBS does not ask about the same conditions, so the data are not comparable.

^ Significantly different from MCBS mean. Exact 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.

The presence of one or multiple functional limitations and chronic conditions is likely to be a contributing factor to the inferior self-assessed health status of our sample of high-risk seniors. These seniors are more likely to be functionally limited than the average Medicare senior, and results in Table II.5 support this in showing that 42 percent of survey respondents do not have any limitations in ADLs or IADLs; much lower than the 63 percent average for elderly Medicare beneficiaries. In fact, every category of functional limitations suggests that the high-risk seniors in our sample are significantly more likely to have functional limitations. In addition, half the seniors in our sample possess three or more chronic conditions, and 15 percent have five or more.

One result that both enhances and reflects the ability of high-risk seniors to overcome the challenges they face is their high level of activity. Previous research has shown that exercise for seniors of advanced age has the effect of minimizing the debilitating effect of their health conditions and functional impairments (Morey et al. 1989). In our sample of seniors in the care management and advanced age subgroups, 65 percent reported that they exercised for 20 minutes or more at least three times during the week before their interview (not tabled).

While seniors in our sample are, on average, more impaired than the general Medicare senior population and are likely to face above-average risks for adverse outcomes, many report currently being in fairly good health. Almost a third report being in excellent or very good health, 42 percent report no functional limitations, and most report having substantial physical activity. Thus, while our sample faces the high risks associated with advanced age, a recent hip fracture or stroke, or other factors that led to their being selected by their MCO’s care management program, they are not frail. For these seniors, a major objective of their care will be to maintain their health and functioning.

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