Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 3. General Perceptions of Care Management

01/01/2002

Among those seniors who knew they had a care manager from their plan, most were satisfied with the help they received and generally agreed that their care manager knew enough about them to plan care effectively (Table V.16). At the same time, less than half these seniors knew the name of their care manager, a measure we used to capture the closeness of the relationship between a senior and care manager. Furthermore, only four percent would contact their care manager if dissatisfied with medical care or with the plan’s coverage decisions.

While seniors in all three risk groups had the same general pattern of results, the group with a recent hip fracture or stroke differed in a couple of noteworthy ways. First, they were more likely to know their care manager’s name. With the high level of care this group receives, this greater familiarity may reflect a higher level of interaction with their care manager for this group (care management satisfaction questions for the hip fracture and stroke sample pertained only to the time since the fracture or stroke). Also, seniors in this group who did not know they had a care manager were substantially more likely to say that they wanted one. This is likely to reflect the organizationally complex care received by seniors with hip fractures or strokes. In our focus groups with these seniors, several mentioned the value of having an advocate who could help them obtain all the required care and to perform all the self-care required for a good recovery. In most cases, these focus group participants said family members had filled this role, but it was easy to see how a care manager would make the process easier for the seniors and their families.

TABLE V.16. Satisfaction with Care Management among Seniors Who Report Having a Care Manager: All Seniors and by Risk Group
  Satisfaction Measures   All High-
  Risk Seniors  
Seniors with
  Advanced Age  
  Seniors in Care  
Management
  Seniors with Hip  
Fracture/Stroke
Gets Enough Help from Plan Care Manager 91.7 90.8 90.9 Not Asked
Agrees Plan Manager Knows Enough About Personal Situation to Plan Care Effectively
   Strongly agree 64.8 63.9 67.0 66.8
   Somewhat agree 22.9 22.0 23.5 24.1
   Somewhat disagree 6.0 6.2 6.5 6.2
   Strongly disagree 6.3 7.8 3.0 3.0
Knows Plan Care Manager’s Name 55.4 58.0 49.3 63.3
Would Contact Care Managed if Dissatisfied with Medical Care 2.1 1.9 2.4 2.2
Would Contact Care Manager if Dissatisfied with Service Coverage Decision 1.7 1.2 2.6 2.3
Would Like to Have Care Manager, Among Those Lacking a Care Manager 23.8 22.3 24.0 39.5
SOURCE: MPR Telephone Survey of 158 high-risk seniors who reported having a care manager from their plan.
NOTE: Figures in the table are percentages weighted to reflect selection probabilities and survey nonresponse. A total of 22.0 percent of all high-risk seniors have a plan care manager, and 8.1 percent have a care manager outside the plan.

There was no significant pattern of differences among MCOs with respect to satisfaction with care management (Table V.17) Thus, while care management may have been more salient among the seniors at Aspen and Kaiser Colorado, all three MCOs produced equivalent levels of satisfaction among those seniors who realized they had a care manager.

TABLE V.17. Satisfaction with Care Management, by MCO
Satisfaction Measuresa   Kaiser Colorado  
(Percentage)
  Keystone East  
(Percentage)
Aspen
  (Percentage)  
Gets Enough Help from Plan Care Manager 87.57 92.59 96.03
Strongly Agrees Plan Manager Knows Enough About Personal Situation to Effectively Plan Care   67.17 62.12 58.02
Knows Plan Care Manager’s Name 57.49 54.79 61.39
Would Contact Care Manager if Dissatisfied with Medical Care 1.82 2.48 1.68
Would Contact Care Manager if Dissatisfied with Service Coverage Decision 1.91 2.04 1.71
Would Like to Have Care Manager, Among Those Lacking a Care Manager 35.21 29.06 31.41
SOURCE: MPR Telephone Survey of 1,657 high-risk seniors from three managed care plans.
NOTE: All measures have been adjusted for case mix.
  1. Unless stated otherwise, all care manager satisfaction measures are defined only for enrollees who have a plan care manager.

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