Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 2. Satisfaction with Their MCOs Was High Among Our Sample of High-Risk Seniors

01/01/2002

Overall Satisfaction with the MCO. Our sample of high-risk seniors seemed quite happy with their MCO. Overall, 93 percent reported that they would recommend their MCO to another person with a similar health condition (Table V.4). While there was some variation among the three risk groups (care management, advanced age, and recent hip fracture or stroke) and among the three MCOs, those differences are generally small. The result is not surprising, given that we sought to include in the study only MCOs with good reputations for care delivery.

In addition to asking about whether the seniors would recommend their MCOs, we asked about other MCO features that we expected might be important for high-risk seniors (Table V.5). These include:

  • Whether they were satisfied that their MCO would pay for needed health care

  • Their satisfaction with their level of out-of-pocket medical expenditures

  • Their satisfaction with the choice of providers offered by their MCO

  • Their perception of the difficulty involved in changing primary care physicians if they wanted to make a change

TABLE V.4. Percent Reporting Would Recommend the MCO to Another Person with a Similar Health Condition
Sample   Percentage  
All High-Risk Seniors 93
Risk Group
   Advanced age 92
   Care management   95
   Hip fracture/stoke 87
Managed Care Organization
   Kaiser Colorado 93
   Keystone East 91
   Medica aspen 90
SOURCE: MPR Telephone Survey of 1,657 high-risk seniors in three managed care organizations.
NOTE: The percentages reported by risk group are weighted to reflect the underlying populations. The percentages reported by MCO are adjusted for differences in case mix.

Almost all our sample of high-risk seniors expressed confidence that their MCO would pay for care that they might need. Among the full sample, 73 percent said they were very satisfied, and another 20 percent said that they were somewhat satisfied. Similarly, our sample of high-risk seniors expressed high levels of satisfaction about the amount of money they had to spend out of pocket for health care. On both measures, seniors in the hip fracture and stroke sample were slightly more likely to express dissatisfaction than the seniors in care management or those with advanced age, but the differences were not large.

TABLE V.5. Components of Satisfaction with the MCOs, by Risk Groups
  Satisfaction Measures   All High-
  Risk Seniors  
Seniors of
  Advanced Age  
  Seniors in Care  
Management
  Seniors with Hip  
Fracture/Stroke
MCO Will Pay for Needed Health Care
   Very satisfied 73.0 72.5a 74.2c 67.5
   Somewhat satisfied 19.8 20.2 19.5 21.7
   Somewhat dissatisfied   3.5 3.7 2.5 4.1
   Very dissatisfied 3.7 3.6 3.8 6.7
Amount of Out-of- Pocket Costs for Medical Care
   Very satisfied 67.6 70.9a 63.1b 62.2
      Somewhat satisfied 19.0 16.8 22.7 22.1
   Somewhat dissatisfied 7.5 6.8 8.4 7.7
   Very dissatisfied 5.8 5.4 5.8 8.1
Amount of Choice with Health Care Providers
   Very satisfied 72.4 72.3 74.6 67.2
   Somewhat satisfied 19.5 19.9 17.1 22.6
   Somewhat dissatisfied 5.2 4.7 6.2 6.1
   Very dissatisfied 2.9 3.1 2.1 4.1
Level of Difficulty Changing Doctors
   Very satisfied 42.6 42.7 42.5 49.4
   Somewhat satisfied 19.1 20.2 16.8 25.9
   Somewhat dissatisfied 17.1 15.7 19.8 5.9
   Very dissatisfied 21.2 21.4 20.8 18.7
SOURCE: MPR Telephone Survey of 1,657 high-risk seniors from three managed care plans.
NOTE: Figures in the table are percentages weighted to reflect the underlying populations.
  1. Based on a X2 tests, the distribution for seniors of advanced age is significantly different from that of seniors in care management and with hip fracture/stroke at the .01 level.
  2. Based on a X2 test, the distribution for seniors in care management is significantly different from that of seniors with hip fracture/stroke at the .10 level.
  3. Based on a X2 test, the distribution for seniors in care management is significantly different from that of seniors with hip fracture/stroke at the .01 level.

We found larger differences among the MCOs with respect to satisfaction with out-of- pocket medical costs (Table V.6). Our sample from Kaiser Colorado had the highest satisfaction with this dimension, with the sample from Keystone East expressing less satisfaction and the sample from Medica/Aspen expressing substantially less. It is impossible to determine the exact reason for this pattern of reported satisfaction with out- of-pocket costs. Our site visits, however, identified a few possible factors. One is the difference in coverage for medications. Kaiser Colorado offered the most comprehensive coverage and Medica/Aspen the least. While the specific benefits differed in many dimensions, a key difference was that Kaiser Colorado’s enhanced benefit option offered unlimited coverage for medications (with a small copayment) for a premium of $39 per month (all benefit descriptions correspond to the time of our site visits). In contrast, Medica covered medications only on its most expensive option, which has a premium of $212 per month and which few of its members purchased. Keystone East was in the middle, covering up to $1,500 a year in medication costs with a $5 to $10 copayment (Keystone’s coverage closely resembled that provided by Kaiser’s basic option). Thus, it seems likely that seniors at Kaiser actually had lower out-of-pocket expenditures for medications and possibly lower out-of-pocket expenditures overall. The differences in coverage reflect the low Medicare payment rates for Medica, as well as the decisions Kaiser Colorado and Keystone East made about the structure of their benefit plans.

We also noted an interesting difference between the IPA and group model MCOs with respect to sample members’ satisfaction with their choice of health providers and with the ease of changing physicians (Table V.6). The sample from Keystone East reported the highest level of satisfaction with overall choice of providers but then expressed substantially lower satisfaction with their ability to change physicians easily.21 While there are many possible factors that might underlie this finding, our site visits suggested that the differences may stem from variations in the IPA and group models used at the three MCOs. Keystone East offered the largest network, with more than 2,600 primary care physicians and 10,000 specialists. At the same time, many of its primary care physicians practiced alone or with only one other physician. In contrast, the Kaiser Colorado and Aspen MCOs had a limited number of clinics where primary care could be obtained. However, the two group models made it fairly easy to switch among physicians within a clinic. While this explanation fits the general pattern of results, it was hard to understand why sample members at Medica/Aspen reported lower levels of satisfaction with provider choice, since Medica offers a very large provider network in addition to Aspen. We suspect that the sample members at Medica/Aspen may have answered the question of choice only in reference to the Aspen group rather than for the entire Medica system.

TABLE V.6. Satisfaction with Costs, by MCO
(Percentages)
Satisfaction Measures   Kaiser Colorado     Keystone East     Medica/Aspen  
Very Satisfied Plan Will Pay for Needed Health Care 71.3 71.7 67.4
Very Satisfied with Amount of Out-of-Pocket Costs for Medical Care 74.4 64.8 48.9
Very Easy to Change Doctors 66.1 34.7 55.2
Very Satisfied with the Amount of Choice with Health Care Providers 67.1 72.3 64.2
SOURCE: MPR Telephone Survey of 1,657 high-risk seniors in three managed care organizations.
NOTE: The percentages reported by risk group are weighted to reflect the underlying populations. The percentages reported by MCO are adjusted for differences in case mix.

View full report

Preview
Download

"constrai.pdf" (pdf, 32.58Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®