‘Promise, Peril’ of Dual Eligible Demonstration Project Studied

Health care researchers yesterday unveiled a portion of a project examining multiple-condition, multiple-provider consumers affected by the California dual-eligible demonstration project. Their briefing included policy directives they think will steer the program toward promise and away from peril.

The HOME Project, through the UCLA Center for Health Policy Research, is an ongoing qualitative study designed to investigate how care and services are arranged for the frail and elderly population targeted by the state’s duals demonstration project, known as Cal MediConnect.

Cal MediConnect is scheduled to launch April 1 in San Mateo County and on May 1 in three other California counties — Riverside, San Bernardino and San Diego. It will automatically enroll roughly 400,000 Californians eligible for both Medicare and Medi-Cal coverage into Medi-Cal managed care plans.

“We’re on the verge of a major policy change in California,” said Kathryn Kietzman, a research scientist at the UCLA Center for Health Policy Research. “Cal MediConnect aims to improve the quality and efficiency of care for dual eligibles. That’s the promise.”

That’s where the title of yesterday’s seminar comes in, Kietzman said: The UCLA briefing was named, “Promise or Peril? How Low-Income Older Californians Are Faring in the Face of Major Health Care Delivery Changes.” 

Given this population’s vulnerability, she said, it’s important to keep them out of peril.

“While there is much promise in this program,” she said, “the transition also has raised concerns. Many people are anxious about the coming changes.”

Researchers have closely followed 54 consumers over the past four years — ones likely to be affected by the transition — to document concerns and the daily struggle of cobbling together care from multiple sources.

“Dual-eligibles manage and maintain a network of formal and informal supports to stay independent in their homes,” Kietzman said. “Our primary goal is to identify how they patch together support, and identify any unmet needs. … And the overarching goal of the project is to put the face on these policy decisions.”

For instance, she said, transportation emerged as one of those components of care that’s often overlooked but makes a huge difference. When transportation is nonexistent, or even just difficult to arrange, doctor’s appointments aren’t kept, referrals aren’t used, care is not delivered, she said.

“We identified persistent gaps in mental health care, dental care and transportation,” said UCLA researcher Jacqueline Torres. “Also, the delivery of information was an issue. Information about changes [in care, providers or services] prompts a lot of anxiety and confusion.”

The policy recommendations are relatively straightforward and deal mostly with the need for communication, Kietzman said.

“The transition holds so much promise, when care is better coordinated it may mean drastically better care and outcomes,” she said. “However, given the fragile heath of this population, the rollout needs to be handled extremely carefully.”

People’s circumstances and needs vary widely, Kietzman said. So, for instance, explaining the transition to someone with cognitive impairment or language issues is very different from explaining it to someone without those challenges.

“The state needs to do a better job of informing them,” Kietzman said. “The success of this program depends on people being properly informed.”

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