Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. B. The Case-Study MCOs Produced High Satisfaction Among High-Risk Seniors


The high levels of satisfaction reported by our sample of high-risk seniors are particularly noteworthy since high-risk seniors generally report relatively low satisfaction with managed care. For example, Nelson et al. (1996) found that:

  • While 91 percent of Medicare beneficiaries enrolled in Medicare risk plans said that they would recommend their plan to their families and friends, only 74 percent said they would recommend their plan to someone with a serious or chronic health problem.

  • The fraction recommending their plan to someone with a serious or chronic health problem was slightly lower among the high-risk groups identified in that study (70 percent, compared with 74 percent for the full sample). These risk groups includes seniors with advanced age, those with functional limitations, and those who reported their health as only fair or poor (as opposed to good, very good, or excellent).

In addition, Nelson et al. found differences in satisfaction among seniors in different types of MCOs. Specifically, they found that enrollees in plans where the predominant model was group or staff were more likely to recommend their plan to someone else who had serious our chronic health problems (80 percent for group/staff, 71 percent for network, and 74 percent for IPA).

Given these prior findings, we were particularly interested in whether the case study MCOs could generate high satisfaction among high-risk seniors. We wanted to know whether it was feasible for these seniors to receive care under a Medicare + Choice plan in a way that yielded satisfaction levels comparable to the generally high levels observed among Medicare + Choice enrollees. While such a finding says little about the overall performance of managed care for high-risk seniors, it does give policymakers a sense of what is possible.

As noted, our findings suggest that an MCO can indeed generate high satisfaction among a sample of seniors with disabilities and chronic conditions. While there are pockets of dissatisfaction, we found that almost all the high-risk seniors in our sample would recommend their MCO to someone with similar conditions. This finding holds among subsamples defined by their risk-group or impairments, and for all three MCOs.

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