Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 4. Perspective of Seniors in Care Management


Many of the seniors who were enrolled in care management programs and participated in our focus groups seemed unaware of care management. (Similarly, in Chapter V we present survey evidence which suggests that many high-risk seniors are unaware of available care management services even when enrolled in care programs.) This does not mean that the programs fail to coordinate care, although it does suggest that many participants will not identify care management programs as a source of information for dealing with their symptoms and illnesses or difficulties accessing care. Participants in the programs that placed greater emphasis on face-to-face meetings were more aware of care management.

At Keystone East and HMO Oregon, the care-managed seniors in our focus group often remembered telephone calls from nurses but did not seem to understand that they were in a care management program whose mission included helping them get the care they needed. Similarly, at Aspen, the seniors recalled assistance they received from nurses but did not express an understanding of the care management program. Only at the Kaiser Colorado focus group did the care-managed seniors seem to understand care management. At that site, many of the seniors even referred to their care manager by name:

Bonnie just bends over backwards to understand what you want and goes out of her way to try to get it. I found that on several occasions she’s better to call than your doctor.

This difference reflects Kaiser Colorado’s care management program, where caseloads are small and care managers meet with seniors during clinic visits, as well as over the telephone. Care managers at Keystone East and HMO Oregon contacted seniors almost exclusively over the telephone and used staff from contracted home health agencies to make any in- home contact or assessments. Aspen had a clinic-based care management system similar to Kaiser Colorado’s, so it was surprising that the care-managed seniors did not understand the care management program better. This may have reflected the newness of the Aspen care management program (which was only a few months old at the time of our visit) or the fact that Aspen’s team approach to care management can divide patient contact among several staff.

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