Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. C. Seniors’ Perception of Care Management

01/01/2002

Care management was the most noteworthy innovation fielded by the case study MCOs. In general, the MCOs used their care management programs to assess the needs and capabilities of seniors with high risks for adverse health and functioning outcomes. The assessments, which often included home assessments, were followed by efforts to coordinate care delivered by the MCO network. The care managers also referred seniors to community-based social service agencies when they needed assistance and services beyond what was covered in the MCO’s Medicare benefit package. In making referrals, the care managers typically followed up to see that seniors had met with the service agencies and that efforts to meet their needs were under way.

While there were many similarities, there were also some important differences among the MCOs’ care management programs. In particular, care management at Kaiser Colorado and Aspen took advantage of their clinic-based approach to primary care. Care managers at these organizations were located in the clinics, where they could interact with physicians and patients on a face-to-face basis as well as by telephone. In contrast, Keystone East’s care managers used the telephone exclusively to contact seniors, although they could order home health visits to assess seniors’ home situations and deliver some medical social work services.

These care management efforts went beyond the basic Medicare benefit package, but they were also more limited than some of the models put forth to assist high-risk seniors. They included some efforts at patient education and advocacy, but those efforts were limited by the general short-term nature of the programs. Kaiser Colorado usually completed its case management episodes within 6 weeks, and Aspen generally completed its in 12. Keystone seemed to take longer but delivered care management only over the telephone, and its care managers had higher caseloads than those of the other two organizations. In contrast, many prior care management demonstrations and literature include longer-term advocacy and monitoring as part of their service package (Chen et al. 2000).

In assessing the care management experiences of our sample of high-risk seniors, we first noted that the three MCOs where we conducted the survey differed in the fraction of elderly Medicare beneficiaries they enrolled in care management. Also, the characteristics of the care-managed seniors differed substantially among those MCOs. Second, we noted that many of the seniors whom we knew to have been enrolled in care management did not know that they had a care manager at the time of our survey. This appears to reflect both a lack of salience of care management and the fact that some seniors may have received their major care management services months before we interviewed them. Third, we found that those seniors who knew they had a care manager were generally quite satisfied with the assistance the manager provided. However, almost none of them would contact their care manager for help resolving problems with medical care or coverage decisions. Finally, we asked the seniors who did not know they had a care manager whether they would want one and if so, whether they would be willing to pay for such a service. These questions revealed a substantial demand for care management. Thus, from the perspective of the high-risk seniors in care management, the help provided by their MCO generates some benefits but also leaves some demands unfilled.

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