Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. APPENDIX A. SUPPLEMENTAL EXHIBITS

01/01/2002

EXHIBIT A.1. Control Variable Means for Hip and Stroke Subsamples
    Total   Plana
  Aspen/Kaiser     Keystone  
Plan
   Aspen and Kaiser Colorado   16.2 (0.2)     100.0 (0.0)   0.0 (0.0)
   Keystone East 83.8 (0.2) 0.0 (0.0)   100.0 (0.0)  
Sample Indicatorsb
   Hip fracture 26.7 (0.2) 51.0 (0.8) 21.9 (0.2)
   Stroke 74.4 (0.2) 49.0 (0.8) 79.3 (0.2)
Respondent Type:
   Sample member 55.4 (2.1) 63.0 (2.3) 54 (2.4)
   Proxy 23.4 (1.8) 20.7 (1.8) 23.9 (2.2)
   Representative proxy 21.2 (1.7) 16.3 (1.9) 22.2 (2.0)
Age
   Under 85 79.0 (0.9) 69.8 (1.1) 80.8 (1.0)
   85 or older 20.8 (0.9) 29.1 (1.0) 19.2 (1.0)
Gender
   Male 44.7 (2.1) 35.9 (2.4) 46.4 (2.5)
   Female 55.3 (2.1) 64.1 (2.4) 53.6 (2.5)
Racec
   White 82.0 (1.7) 95.1 (1.0) 79.4 (2.1)
   Black 16.4 (1.7) 2.2 (0.4) 19.2 (2.0)
   Other 1.6 (0.5) 2.7 (0.9) 1.4 (0.6)
Education
   Did not complete high school 36.9 (2.1) 24.1 (2.2) 36.5* (2.4)
   High school graduate or above   63.1 (2.1) 75.9 (2.2) 60.5* (2.4)
Total Household Income
   Less than $10,000 26.9** (2.2) 23.5 (2.4) 27.7** (2.6)
   $10,000 or over 73.1 (2.2) 76.5 (2.4) 72.3** (2.6)
Health Assessment
   Excellent or good 68.0 (1.8) 70.7 (2.5) 67.5 (2.2)
   Fair or poor 32.0 (1.8) 29.3 (2.5) 32.5 (2.2)
Lives Alone 22.1 (1.8) 32.1 (2.7) 20.2 (2.0)
ADL Limitationsd
   Two or fewer 77.5 (2.0) 84.8 (2.2) 76.2 (2.3)
   Three to five 22.5 (2.0) 15.2 (2.2) 23.8 (2.3)
Number of Chronic Conditionse
   Two or fewer 35.7 (2.0) 36.5 (2.6) 35.6 (2.3)
   Three or four 40.2 (2.1) 40.6 (2.6) 40.1 (2.4)
   Five or more 24.1 (1.8) 22.9 (2.4) 24.3 (2.1)
Alzheimer's or Other Dementia 14.0 (1.5) 13.2 (1.5) 14.1 (1.7)
SOURCE: Sample of 387 respondents in the hip fracture or stroke subsamples taken from a 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.
  1. Aspen and Kaiser Colorado are combined for the hip and stroke subsamples because of their small sample sizes.
  2. Percentages will sum to more than 100 because some seniors are in multiple sample frames.
  3. Race categories are different from those in Table II.4 because we were unable to control for ethnicity, as a result of the small number of Hispanics. Ethnicity is therefore ignored as a control variable, and Hispanics are classified into their corresponding race category.
  4. ADL limitations involve the need for help or supervision with the five activities of daily living: bathing, eating, dressing, transferring, and toileting. These questions were asked of the 1,399 community residents only.
  5. People were asked whether they had been diagnosed with any of the following chronic conditions: arteriosclerosis, hypertension, heart attack, other heart disease, previous stroke, depression, cancer, diabetes, arthritis, asthma, previous hip fracture, or Alzheimer's or other dementia.

* 5 to 20 percent nonresponse.
** Over 20 percent nonresponse.

 

EXHIBIT A.2. Marginal Effect of Selected Characteristics on the Probability of Reporting Inadequate Information for Plan Selection, Dissatisfaction, or Uncertainty About Addressing Complaints
(Percentage Point Change)
  Individual Characteristics     Whether a Senior Reports  
Having Inadequate
Information for Selecting
the Best MCO
  Whether a Senior Would  
Not Recommend Their
MCO to a Senior with
Similar Health
Whether a Senior Has No
Concrete Plan for
  Addressing Dissatisfaction  
with Medical Care
Aspen Member 3.4 4.1 5.3
Keystone Member 0.2 2.7 - 0.6
Survey Completed by a Proxy Respondent 2.9 5.1** - 0.2
Survey Completed by a Representative Proxy - 7.7*** 6.3** - 15.4***
Female - 2.1 -- 3.1
Self-Reported Good Health 2.5 0.8 - 3.9
Self-Reported Fair Health 2.6 5.7** - 1.9
Self-Reported Poor Health 8.3* 4.7 --
Age 75 to 84 Years Old 4.2 4.0 2.9
Age 85 Years or Older 6.8 - 1.6 15.4***
Race: Black 2.5 1.7 1.8
Race: Other Nonwhite - 2.0 3.6 2.1
Annual Income: $10,000 to $20,000 - 3.2 -4.4** - 2.7
Annual Income: More than $20,000 - 1.6 - 3.7 - 4.6
Annual Income Variable Missing -- - 1.9 4.4
Medicaid Coverage - 1.8 - 1.5 2.9
Medicaid Variable Missing 8.7* - 2.8 8.2*
Married 0.7 - 1.8 6.9*
Living Alone 5.2 1.6 0.3
Living Arrangements Missing - 1.9 - 1.9 - 6.2
3 to 4 Chronic Conditions 0.2 - 1.8 - 1.3
5 or More Chronic Conditions 2.5 1.8 - 6.7*
Educational Attainment: High School 0.4 1.8 - 4.4
Educational Attainment: at Least Some College 3.2 2.3 - 6.0*
Limited in 3 to 5 Activities of Daily Living 2.9 7.8** - 0.4
Activity of Daily Living Measure Missing 6.5 10.2** 5.8
Selected in the Advanced Age Risk Group - 4.2 4.6 - 6.0
Selected in the Hip Fracture Risk Group - 10.7*** 1.3 - 9.7**
Selected in the Stroke Risk Group - 4.2 3.4 - 4.9
Alzheimer's Disease or Other Dementia - 3.8 - 0.8 - 2.2
Constant - 28.1 - 29.3 20.7
SOURCE: MPR telephone survey of 1657 selected high-risk seniors in three managed care organizations.
NOTE: The marginal effects shown in the table indicate the percentage point change in a dependent variable that would result from changing each of the independent variables from 0 to 1. For example, in the first column, the coefficient on the variable ASPE shows that a person who was a member of Aspen rather than Kaiser Colorado (the excluded category) would be 3.4 percentage points more likely to report having had inadequate information for selecting the best MCO. Given the way the dependent variables are defined, a negative sign on a marginal effect would reflect a more desirable situation.

- Value is less than 0.5 percent.
* Significantly different from zero at the .10 level, two-tailed [or one-tailed] test.
** Significantly different from zero at the .05 level, two-tailed [or one-tailed] test.
*** Significantly different from zero at the .01 level, two-tailed [or one-tailed] test.

 

EXHIBIT A.3. Time Lapse Between Hip Fracture and Wave I Interview
Bar chart.

 

EXHIBIT A.4. Time Lapse Between Stroke and Wave I Interview
Bar chart.

 

EXHIBIT A.5. Time Lapse Between Hip Fracture and Wave II Interview
Bar chart.

 

EXHIBIT A.6. Time Lapse Between Stroke and Wave II Interview
Bar chart.

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