Survey: Low-Income Elderly Reject Calif. Managed Care Experiment For Fear Of Change

A large share of  low-income elderly Californians have opted out of a statewide managed care experiment because they feared losing their doctors and were reluctant to make any changes to their health care, according to survey data released Tuesday by the Field Poll.

California is in the middle of a three-year pilot project aimed at nearly 500,000 of the state’s most costly patients – so called “dual eligibles.” The beneficiaries receive both Medicare, the health insurance program for seniors and the disabled, and Medicaid, or Medi-Cal in California, which provides coverage for the poor.

The state program, known as Cal MediConnect, has had a high rate of people opting out — about 47 percent, according to the state Department of Health Care Services.

“Resistance to change is not surprising,” said Mark DiCamillo, senior vice president of the Field Research Corp. “It is an older population … The status quo is the easiest course.”

In some cases, DiCamillo said, their fears were valid. Nearly 30 percent of those enrolled in the new managed care program ended up with a different personal doctor, according to the survey. About the same percentage of enrollees in the program said they had been seeing their doctor for one year or less.

But once they are enrolled, less than 10 percent have decided to leave the program, according to the state. About 80 percent of enrollees said they were very or somewhat confident they could get their questions answered and that they know how to manage their health conditions, the poll found.

The experiment, which has about 117,000 enrollees, is designed to provide more coordinated care and to improve enrollees’ health, reduce their costs and help keep them in their homes. The participants typically have multiple chronic diseases and until now, have bounced between two government systems. Medicare pays for most doctor visits and hospitalizations and Medicaid covers nursing homes and long-term care.

The fact that people who enroll in the program stay enrolled is encouraging, said Jennifer Kent, director of the Department of Health Care Services. “The reason they are staying in the program is that they are satisfied with and in some cases, really pleased with the care,” she said.

Kent said it continues to be a challenge, however, to get the message out to beneficiaries about the advantages of being in a more coordinated program. “A lot of individuals think they are losing benefits,” she said. “We are working really hard to assure people that is not the case.”

Kent also said the state is evaluating the program to ensure that it is doing what it was intended to do – save money and improve care.

William Averill, a Torrance, Calif. cardiologist who treats many dual beneficiaries, said he doesn’t believe that the program is accomplishing that goal and that many people have been automatically enrolled without being aware of the change.

“The most vulnerable people were the ones who weren’t in a position to understand their choices,” he said. “I think the whole thing is going to collapse under its own weight.”

The survey was the first of four planned polls in 2015 and 2016 of 2,502 dual eligibles in California. The first round included 1,394 enrollees in the Cal MediConnect program in five California counties and 678 who opted out. Surveyors also interviewed 430 people in counties where the program is not being implemented.

The survey research was funded by The SCAN Foundation and done in conjunction with the California Department of Health Care Services.

agorman@kff.org

agorman@kff.org

Kaiser Health News receives support from The SCAN Foundation for coverage of aging and long-term care issues.

Blue Shield of California Foundation helps fund KHN coverage in California.

 

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