Smooth Landing?: How California Can Ensure Continuity of Care for Vulnerable Seniors Transitioning to Managed Care

​On April 1, 2014, the first of an estimated 450,000 "dual eligibles" (adults insured through both Medicare and Medi-Cal) in eight counties were enrolled in a combined Medi-Cal and Medicare managed care program called Cal MediConnect. Cal MediConnect holds the promise of addressing unmet needs and improving the coordination of their care across a complex array of medical and social support services. However, concerns remain about the transition, and specifically whether it will result in disruptions in care.

This policy note documents what continuity of care actually means in the day-to-day lives of older adults affected by the transition. Through interviews with dozens of older adults potentially eligible for Cal MediConnect -– all of whom are managing multiple chronic conditions and disability -– the authors report that continuity of care is best achieved through care that is familiar and responsive, is assured through long-standing relationships with providers, and involves family members, social service providers, and others who are invested and instrumental in meeting their needs.   The authors recommend that the state's definitions and assurances of care continuity be expanded to better reflect the broader health and social care needs of consumers. Likewise, the evaluation of quality care should be rooted in the consumer experience, and use metrics that account for the preferences and goals of consumers themselves.  

Publication Authors:

• Kathryn G. Kietzman, PhD, MSW
• Jacqueline Torres, MPH, MA
• Charlene Chang
• Tina Duyen Tran
• Steven P. Wallace, PhD