Evaluating California's dual eligible program
I'm not a person with particularly complex healthcare needs. That said, over the course of my life, I've seen a series of crummy physicians, ranging from those with a poor bedside manner who left me in tears to those who pushed duplicate tests, unnecessary procedures or ill-advised medications.
That's why I was pleasantly astonished to see results from a California study that indicates those in a Medicare/Medi-Cal program with complex medical needs, i.e. dual eligibles, report they're happy with their care. The study was done with the SCAN Foundation and the California Department of Health Care Services by Field Research Corporation.
The survey is the third in a series, which started in fall 2015, and was conducted between February and April of this year. A total of 3,301 adults or their proxies were interviewed.
Granted, the results do not necessarily say Cal MediConnect enrollees are more satisfied than those who opted out or those in non-CMC counties. But let's take, for example, a question asking how long people had to wait to see a physician. For CMC enrollees, the average over three waves studied was that 75% of people said they were satisfied or very satisfied with their wait time. With the opt-outs, it was 79%, and the non-CMC average was 85%. While that 10% gap between non-CMC and CMC should be examined, we can do that while still acknowledging that three-fourths of CMC enrollees say they can see someone when they need to. Given the long wait time many of us have to see specialists, that's not nothing.
Similarly, 87% of CMC participants say they are satisfied with the amount of time they spend with a doctor, which is up by 4%. Other questions around health plans explaining benefits, choice of doctors and care coordination, all saw increases in satisfaction ratings. In the third wave, 91% of enrollees said they have a doctor they think of as their personal doctor, and 84% said they are satisfied with their health plan information explaining benefits.
“There are higher levels of satisfaction,” said Mark DiCamillo, senior vice president and director of The Field Poll.
He noted people who opt-out tend to be in poorer health. According to the survey, in the non-CMC group, there are higher percentages of those who require assistance with daily activities and who need specialized equipment: These tend to be older, sicker women. Yet by wave three, all three groups — the CMC, opt-outs and non-CMC participants — clocked with 20% saying their health as “excellent” or “very good.”
One area of concern to me was that there was a 7% gap between CMC and non-CMC enrollees around whether they have a personal care plan since this matters so much for seniors. In such a large sample, that deserves more attention. Among those without a care plan, when asked if they thought one would improve their care a lot, a little or not at all, 22% of both the CMC and non-CMC groups said “a lot.”
Overall, the progress is notable given that, as SCAN's Bruce Chernof wrote in McKnight's in 2015, only 14% of eligible beneficiaries enrolled in 2014. Since the dual project targeted about 430,000 out of a million Californians who are dual eligibles, the roughly 117,000 people who signed up originally was disappointing. That was at least partially due to providers and family members encouraging people to opt out, as well as a totally understandable hesitancy to change programs. As a research scientists at UCLA's Center for Health Policy Research said, the program had a “rocky start,” and the center conducted research on asking consumers why they were opting out.
Asking that question is one area where progress can be made, as is telling people that these types of projects don't mean poor care. Many dual eligibles have low health literacy, which the state addressed at least in part by sending a new CMC toolkit in late 2015.
But for those in long-term care, whether it's in California or far beyond, there's also a responsibility to encourage use of research and resources, rather than traffic in gossip. Encourage families to look at the data, and recognize that the dual eligible population has stymied policymakers and providers for eons.
The fact that California is making steady progress deserves recognition. Plus, as Field continues to examine data and aggregate information across counties, it is “fine-tuning our assessments,” DiCamillo said. “Some of the findings will get more interesting over time.”
Follow Elizabeth Newman @TigerELN.