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New Survey Offers First Data on Managed Care Shift

A survey released yesterday revealed strengths and weaknesses in the state’s 2011 transition of about 172,000 seniors and persons with disabilities into Medi-Cal managed care plans.

Two-thirds of the responding beneficiaries said their care was the same or better than it had been before the transition but the survey raised concerns on several fronts, most notably a lower level of notification and communication, according to Carrie Graham, assistant director of research at  Health Research for Action at UC-Berkeley School of Public Health. Health Research for Action conducted the survey in partnership with the California HealthCare Foundation, which publishes California Healthline.

The survey reached 1,521 Medi-Cal-only respondents who transitioned into managed care between June 2011 and April 2012. Graham said there was a 59% response rate to the survey.

“In most areas, about two-thirds of those who responded said the transition worked for them, that they experienced better or the same care,” Graham said. “But one-quarter to one-third reported problems with notification.”

Most respondents did not have trouble getting a medical provider, but many did report problems with their prescriptions, specialist care and in getting needed medical equipment.

“Almost half of beneficiaries said they don’t know how to get their medical equipment and supplies,” Graham said, “or how to make an appointment with a specialist.”

The survey itself can really help inform state officials — not just about what needs improvement, but also about what went right — according to Gary Passmore, vice president of the California Congress of Seniors.

“Most of the information we’ve had till now has been anecdotal,” Passmore said. No one calls legal aid to talk about how wonderful the transition is going, he said. “We have heard horror stories about this transition. But from this data, we see it’s really a mixed bag. Some things we did pretty well, and some we didn’t do very well.”

According to Margaret Tatar, chief of the Medi-Cal Managed Care Division at the Department of Health Care Services, the survey data will help the department do things better in the upcoming duals demonstration project, now known as Cal MediConnect. The duals project, designed to coordinate care for people eligible for both Medi-Cal and Medicare, this week received federal approval to launch as soon as October 2013.

“On an overall aggregate snapshot, about 72% reported that their care improved or stayed the same. Naturally, though, we’re focused on the lessons learned,” Tatar said, “and how we can change, modify or improve our program.”

In particular, Tatar said, it’s important that providers understand the continuity of care provisions, and to make sure the beneficiaries understand their right to switch plans.

“The challenge for us is to apply the things that worked well here, and learn from the things that didn’t.” Tatar said.

At yesterday’s presentation to announce the preliminary survey findings, Silvia Yee, a senior staff attorney at Disability Rights California, said that if two-thirds of respondents felt their care was equal or better, people need to remember that an estimated one-third didn’t’ — and that’s a lot of people, given the 172,000 people in the transition.

“Growing up in Canada, I was a stereotypical Asian kid who came home waving a 99% on a test, and I’d get the question: What about that other 1%?” Yee said. Her job now, she said, is to focus on the “other” percent.

“Those percents are people,” Yee said. “On the individual level, [this transition] was bad, given that continuity of care was disrupted. These people have the thinnest margin of good health. And this study seems to substantiate our fears that many beneficiaries are not getting proper care.”

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