What do seniors want from managed care? Consistency.

New study documents concerns of California's "dual eligibles" about new managed care pilot program

Giving low-income older adults in California a voice in their own medical and social care is critical to making a seamless transition from a fee-for-service system of health care into a new managed care program, according to a new policy note by the UCLA Center for Health Policy Research.

In April, the state began moving more than 450,000 vulnerable Californians eligible for both Medicare and Medi-Cal coverage in eight counties into a managed care pilot program called Cal MediConnect.  The program aims to better coordinate medical care and long-term services and supports.

With support from The SCAN Foundation, the study's authors interviewed 39 seniors potentially eligible for the program and found that the majority were concerned about maintaining long-standing relationships not just with medical providers, but with in-home caregivers, as well as social service, transportation, equipment and other support staff. The study also documented the important role played by family members, caregivers and others in helping seniors make informed decisions about their care.

"Ultimately, the state has to recognize that the consumer is the expert in knowing what kind of care he or she wants," said Kathryn Kietzman, a Center researcher and lead author of the study. "Their concerns need to be heard."

The new Cal MediConnect program affects Californians, who use Medicare and Medi-Cal services and live in Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties. The majority of those eligible for Cal MediConnect are over 65 years of age.

Among the findings:

Consistency is key
Keeping the same long-term primary care doctor or specialist is the biggest concern for seniors, but it may not be possible in the move to managed care, according to the study's authors.

"Familiar faces ― whether daily caregivers or doctors they see once a month ― are safe, consistent figures," Kietzman said of the seniors. "They may choose to make some changes, but they need information and support."

Family, other support critical
The study reinforces the importance of a patient's family in helping seniors maintain independent living. The family is often the patient's strongest advocate, the study says, especially if language barriers are present.

However, seniors without family advocates say they sometimes rely on social service workers and other non-family providers to help them get the best medical and social care. And while the transition to managed care may inevitably exclude some service providers, it does give some seniors access to new supportive services, such as transportation and vision benefits.

Gaps in coverage
Mental health, dental and transportation services showed gaps in current coverage ― gaps that Cal MediConnect aims to address, the study says.

For instance, some participants said they discuss moods and emotional issues with family members, but getting access to a mental health professional is difficult. When they do get a referral, for depression as an example, it is usually when they are least able mentally to follow through and get to a doctor’s office. And they said having a therapist come to their home is out of their financial reach.

Most participants have gone without dental care since 2009, when DentiCal benefits were cut, and were anxiously waiting for reinstatement of the program on May 1 to get long-delayed treatment, the study said. Most can’t afford out-of-pocket dental costs.

And lack of reliable transportation often causes breakdowns in continuity of care, the study says. In one case, weekly physical therapy was dropped because of transportation glitches; in another, a senior passed on socializing at a community center to save his energy for getting to and from medical appointments that required him to take multiple forms of public transportation to disparate parts of the city.

Recommendation: A better transition
The authors recommend that the state make the definition of "continuity of care" more robust to include social workers, medical equipment providers and other health and social support services that are currently excluded.

Also, affected seniors must be fully informed of changes to their services and benefits in a clear and concise way and actively involved in what decisions they have control over.

Finally, someone must continuously monitor and evaluate their transition to Cal MediConnect and make sure care is truly "person-centered" and responsive to the concerns of individual consumers.

Read the policy note: Smooth Landing?: How California Can Ensure Continuity of Care for VulnerableSeniors Transitioning to Managed Care

About the UCLA Center for Health Policy Research
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit healthpolicy.ucla.edu.

The SCAN Foundation advances a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.