Poll Asks Duals for Opt-Out Reasoning

According to Field Poll results released yesterday, most of the Californians dually eligible for Medi-Cal and Medicare who are opting out of a program designed to improve care coordination are choosing not to join for a relatively simple reason — they’re wary of altering their care.

“It’s really a fear of change,” said Mark DiCamillo, senior vice president of Field Research who led the study. “This population just didn’t want to change their health care services, or they were concerned they might potentially lose their personal doctor.”

The other major finding, he said, is that 70% of the people who had not opted out and instead enrolled in Cal MediConnect were well-satisfied with their care.

“I had been reading about all the problems Cal MediConnect was having,” DiCamillo said. “But you’re looking at 70% satisfaction and that’s extremely good, so that was somewhat surprising to me.”

The survey polled those eligible for Cal MediConnect — also known as the duals demonstration project — in five of the seven counties where it is offered. The program combines the services and funding of Medicare and Medi-Cal benefits in an attempt to better manage care for the frail and elderly duals population.

The survey has not yet polled anyone in Orange County, where the opt-out rate has been the highest of the seven counties. Those Orange County surveys will start in 2016, DiCamillo said. However, opt-out rates also have been much higher in Los Angeles County — and DiCamillo said there was not much statistical difference in the answers and attitudes of people in LA County compared to people in the other four polled counties. 

“Looking at LA versus non-LA, there wasn’t much difference to speak of,” DiCamillo said. “In general there weren’t that many differences between counties.”

Given the demographics of the duals population – older, with multiple chronic conditions, multiple medications, with limited English proficiency, limited education and a higher percentage of those with cognitive issues — it makes sense that a higher percentage of them might opt out of a new program, DiCamillo said.

“The opt-outs [in comparison to those in Cal MediConnect] tend to be in poor health, tend to use a cane or a wheelchair, are more likely to be sicker,” DiCamillo said.

“If you had to generalize you’d say they’re a little older, a little worse health and they don’t want to change,” he said. “They’re less willing to change into a new program.”

The SCAN Foundation paid for the surveys to be conducted, DiCamillo said, and they’re being completed in conjunction with the California Department of Health Care Services.

Categories: Capitol Desk, Medi-Cal, Medicare