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


Many high-risk seniors, as a result of their multiple chronic conditions and functional limitations, face the challenge of coordinating care from multiple providers. If care is not properly coordinated, then the potential of seniors having unmet personal care needs is greater. Other challenges arise from the Medicare benefit package, which excludes coverage for most medications, personal support services, and long-term custodial care. Some of these services can be obtained through community agencies, but even then there are often waiting lists. Moreover, the rapid technical change of health care delivery may have caused the expectations of high-risk seniors to diverge from current practice patterns, which could create misunderstandings between beneficiaries and providers.

TABLE III.5. Complexity of Care for High-Risk Seniors
(Percentages and Their Standard Errors)
    Survey Sample  
Number of Specialists Seen in Past Six Months
   None 39.5 (1.7)
   One 31.7 (1.6)
   Two 19.9 (1.4)
   Three or more 9.0 (0.9)
Number of Prescriptions Taken Daily
   None 14.2 (1.3)
   One to three 44.3 (1.8)
   Four or five 23.2 (1.5)
   More than five   18.3 (1.3)
Number of People Assisting with Daily Living Activities
   None 55.8* (1.7)
   One 25.4 (1.5)
   Two or more 18.8* (1.4)
Number of Assistive Devices Used
   None 54.8 (1.7)
   One 22.5 (1.5)
   Two or more 22.7 (1.4)
SOURCE: 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 and are weighted to represent the population and correct for nonresponse. Standard errors are in parentheses.

* 5 to 20 percent nonresponse. No variables in this table had more than 20 percent nonresponse.

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