Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. ACKNOWLEDGMENTS


This report is dedicated to improving care for seniors with disabilities or chronic illnesses. Our goal has been to help people who are responsible for designing and implementing care systems for this high-risk group. In particular, we have looked for ways to learn from the structures and processes that four innovative managed care organizations (MCOs) have used to care for a selected group of seniors who had high risks of hospitalization or other adverse health or functioning outcomes.

This report draws extensively on the experience and operations of the four MCOs that participated: Keystone Health Plan East, Regence HMO Oregon, Kaiser Permanente, Colorado, and Aspen Medical Group. We are indebted to the staff at these organizations who conferred with us during our site visits, shared documents with us, and commented on drafts of this report. We are also indebted to the many care managers and physicians who participated in our focus groups. We hope we have fairly and accurately described their programs and the enthusiasm they bring to serving high-risk seniors.

We spoke with many high-risk seniors at these organizations, either in focus groups or as part of our survey. They provided many insights into their care needs and into how care delivery systems appear to the people they are intended to serve. The study could not have been done without these people, and we greatly appreciate their participation.

The study was conceived, funded, and nurtured by staff at the Office of Disability, Aging, and Long Term Care Policy in the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services. In particular, Jennie Harvell played an active part is shaping this study and report. Her advice and knowledge of the long term care system helped to improve this study and report in many ways. Other ASPE staff also provided helpful advise and information throughout the course of the study, including Hunter McKay, William Marton, Floyd Brown, Mary Harahan, and Ruth Katz.

At Mathematica, we benefited greatly from the analytical assistance provided by Rachel Thompson, Kimberly Neuman, and Cindy Woo. Marsha Gold helped immeasurably with her insights about Medicare managed care. She also led our efforts to develop a conceptual framework for this study. The survey could not have been conducted without the supporting efforts of Jennifer Fearing, Linda Mendenko, and Jackie Donath. Michael Sinclair and Frank Potter developed the sample weights used to make the survey data generally representative of the corresponding populations in the three MCOs.

The project also benefited from the advice of our Technical Advisory Group, who helped us design the study and identify innovative MCOs. They also provided very helpful and insightful comments on this report. The group included the following people:

  • Sherry Aliotta, RN, BSN, President, SA Squared, Inc.

  • Diane Archer, JD, Executive Director, Medicare Rights Center, Inc.

  • Rachel Block, Director, Finance Systems and Quality Group, Centers for Medicare and Medicaid Services

  • Richard Bringewatt, President, National Chronic Care Consortium

  • Richard Della Penna, MD, Director, Kaiser Permanente Aging Network

  • Tom Hoyer, Director, Chronic Care Policy Group, Centers for Medicare and Medicaid Services

  • Stanley Jones, PhD, Director, Health Insurance Reform Project, George Washington University

  • Jeff Kang, MD, Director, Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services

  • Andrew Kramer, MD, Research Director, Center on Aging, University of Colorado Health Science Center

  • Katie Maslow, PhD, Managed Care Consultant, Public Policy Office, Alzheimer’s Association

  • Nancy Miller, Director, Division of Risk Management, Centers for Medicare and Medicaid Services

  • Richard Price, Director, Health Section, Congressional Research Service

  • Cary Sennett, MD, Vice President of Performance Measurement, National Committee for Quality Assurance

  • Robyn I. Stone, PhD, Executive Director, Institute for the Future of Aging Services

The report was produced by Cindy McClure with help from William Garrett, Monica Capizzi, Cathy Harper, and Jill Miller. It was edited by Walt Brower and Roy Grisham.

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