Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. CHAPTER V. HIGH-RISK SENIORS’ PERCEPTIONS OF THEIR MANAGED CARE EXPERIENCES


The high-risk seniors included in our study generally held very favorable opinions of their managed care organizations (MCOs). More than 90 percent indicated that they would recommend their MCO to another person with similar health conditions. This figure is much higher than the overall satisfaction level previously reported for a national sample of high-risk groups in Medicare + Choice plans (Nelson et al. 1996). In fact, it is approximately equal to the level reported by the largely unimpaired general Medicare population in Medicare + Choice plans. This high satisfaction level is testimony for the potential of managed care to serve high-risk populations well.

We found that the perceptions of high-risk seniors in care management programs generally reflected the structure of the programs that the case study organizations fielded. These organizations tended to provide care management that focused on short-term interventions. As a result, many of the seniors who had been enrolled in care management did not remember being enrolled when we interviewed them. When they did remember, they tended to report being satisfied, although very few would have turned to their care manager to resolve a problem with care or coverage.

This chapter reviews the survey data we collected about the satisfaction levels and care management experiences of our sample of high-risk seniors in the three case-study MCOs where we conducted surveys (Aspen, Kaiser Colorado, and Keystone East). For the sample members at Aspen, we asked separate questions about their satisfaction with their Medicare + Choice plan (Medica) and with care at Aspen. When discussing characteristics of Medica, rather than those that pertain only to Aspen, we will use the term Medica/Aspen.

We begin with a review of the reasons that our sample of high-risk seniors gave for enrolling in a Medicare + Choice plan. We also investigated whether these seniors felt that they had enough information to make a good choice of MCO. This information provides useful insight into the context in which people enroll. Also, their expectations about managed care are likely to influence their satisfaction levels. For example, an early study of Medicare managed care found that enrollees saw many disadvantages of being in managed care but also felt that the savings they received by enrolling outweighed those disadvantages (Brown et al. 1993).

The chapter then turns to the estimated satisfaction levels, including satisfaction with the MCO overall, as well as with specific aspects of care delivery. We then present the findings, including an analysis of the generally high levels of satisfaction among subgroups of the seniors and among all three MCOs.

Finally, the chapter turns to seniors’ care management experiences. That analysis begins with the subsample of seniors who we know were enrolled in care management (although not all were still actively involved with care management at the time of the survey). Data from this sample highlight the fact that care management is often not salient to many of the seniors who receive such services. These data also illustrate how the three MCOs differed with respect to the people they enrolled in care management. Moving from that specific care management sample, the chapter proceeds to examine the experiences of all sample members who reported receiving care management. While this sample undoubtedly excludes those seniors for whom care management was not salient, their experiences and perceptions illustrate the successes and challenges facing the highly focused types of care management implemented by the three case-study MCOs.

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