Dual-Eligibles Don’t Want Any Surprises

Enrollees in both the Medicare and Medi-Cal programs want their coverage to remain consistent as the state of California moves them into managed care health plans.

That was the conclusion of UCLA researchers, who interviewed 39 seniors who are being migrated into managed care coverage under the Cal MediConnect program. Altogether, about 455,000 dual-eligibles in eight counties statewide began being moved into the program on April 1 in order to better coordinate the care they receive and reduce costs.

The biggest concern among seniors who were interviewed was preserving the continuity of care, which to them meant having a long-term relationship with either a primary care or specialist physician who is aware of their medical history.

However, the report acknowledged that if dual eligibles do not opt out of Cal MediConnect, they will be enrolled in managed care default.

"Ultimately, the state has to recognize that the consumer is the expert in knowing what kind of care he or she wants," said Kathryn Kietzman, a researcher with the UCLA Center for Health Policy Research and lead author of the study. "Their concerns need to be heard."

At the same time, the report also noted that many seniors they had interviewed had experienced gaps in obtaining care under the fee-for-service model, including problems obtaining dental services, mental health services and transportation to providers. “Many consumers are currently lacking certain components of care and support that are essential for their continued health and well-being. Where gaps exist, continuity is not possible,” the report said.

Nevertheless, the report concluded that when given a choice, “most would elect to stay with the providers and caregivers they trust, who are familiar with their personal history and health conditions. After weathering years of reductions to their...benefits, these consumers are understandably wary of any additional changes to their health and social care services and benefits.”

The report recommended that the Cal Mediconnect program expand the definition of the continuity of care to “include social workers, durable medical equipment providers, incontinence supply providers and other health support personnel.”

The UCLA researchers also recommended that enrollees are clearly informed of their options and rights and and that the program's transition be monitored, preferably in real time.

“The realization of care continuity and better care outcomes will require careful and continuous monitoring,” the report said.