Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. A. Potential Savings and MCO Reputation Were Primary Reasons That High-Risk Seniors in Our Sample Enrolled in Managed Care


The seniors in our sample gave a diverse mix of reasons for enrolling in their Medicare + Choice plan, but the potential for savings and the reputation of the plan were the most frequently cited (Table V.1). About 55 percent of our sample named one of them as the most important factor in their enrollment decision. The other reasons varied. About five percent of the sample reported enrolling because their physician or a desired hospital was in the plan’s network. In addition, a few seniors had been enrolled in the plan before they became eligible for Medicare, and decided to stay with their plan. Others gave a variety of responses, including that they joined because their spouse was already a member. Finally, a substantial number gave no specific reason for enrolling.

Among the three MCOs, the most noteworthy difference is between Keystone East and the two other MCOs in the fraction of members who said that they enrolled to save money. Whereas about 18 percent of Kaiser Colorado and Medica/Aspen members reported that saving money was the most important reason for enrolling, 41 percent of Keystone East’s members gave that reason. Based on discussions during our site visits, this difference appears to reflect differences in the Medicare payment rates and the resulting differences in the managed care prices and benefit package. Medicare rates are substantially higher in the Philadelphia area served by Keystone East than in the areas served by the other two MCOs (Table II.2). As a result, Keystone East can offer a more generous benefit package and lower premiums than other two organizations. In contrast, staff at Medica/Aspen indicated that Medicare supplemental policies could be purchased in the Minneapolis-St. Paul area for approximately the same premiums charged by the managed care plans. Thus, the Medica plan could not offer any savings relative to the Medicare fee-for-service sector, and correspondingly, seniors had to enroll for reasons other than a desire to save money.

TABLE V.1. High-Risk Seniors’ Most Important Reason for Enrolling in Their MCO
Sample Group Most Important Reason for Enrolling in Medicare + Choice Plan
in Plan
  No Specific  
TOTAL SAMPLE   35 22 5 2 28 9
   Medica/Aspen 14 14 4 3 39 26
   Kaiser Colorado   16 27 6 3 40 8
   Keystone East 42 21 5 2 23 7
SOURCE: MPR telephone survey of 1,657 selected high-risk seniors in three managed care organizations.
NOTE: In some cases, the percentages for the individual reasons sum to more than 100 percent because of rounding. Data are weighted to reflect the relevant populations in each MCO, including corrections for survey nonresponse.

The vast majority of our sample of high-risk seniors (85 percent) thought that they had had enough information to select the MCO that would serve them best (Table V.2). There were no important differences among the three organizations on this measure.

  TABLE V.2. High-Risk Seniors Who Generally Report Being Informed for Selecting Their MCO  
Sample Group Had Enough Information About All
  Available Plans to Pick the Best One  
   Medica/Aspen 81
   Kaiser Colorado   85
   Keystone East 87
SOURCE: MPR telephone survey of 1,657 selected high-risk seniors in three managed care organizations.
NOTE: Data are weighted to reflect the relevant populations in each MCO, including corrections for survey nonresponse.

Nevertheless, policymakers might be concerned about the 15 percent of the sample who felt that they had not had enough information to select the best plan. It is particularly troubling that in our sample, the seniors who reported having poor health were more likely to report not having had enough information, although they may not have been in poor health at the time they made their enrollment decision (Appendix Exhibit A.2).20 Those who had a representative proxy complete the survey (an indication that they were not managing their own medical affairs) or a recent stroke were less likely to say they lacked sufficient information. This finding may reflect the active role a representative proxy plays in arranging the care for the sample member. While these results pertain specifically only to our case study MCOs, they suggest that it may be worthwhile for policymakers to pay special attention to ensuring that information is provided to people with poor health. Other studies (Gold and Stevens 2001) suggest that special efforts should target seniors with low education, although we found no independent effect of low education per se on whether a senior reported not having enough information.

View full report


"constrai.pdf" (pdf, 32.58Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®