Rutgers University Survey of Consumers with Developmental ... · May 21, 2004 Transitions into New...

May 21, 2004 Transitions into New Jersey Care 2000+www.cshp.rutgers.edu

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Rutgers University Survey of Consumers with Developmental Disabilities Enrolled in Medicaid

Managed Care

Presentation to the15th Annual Conference on

Medical Care for People with Developmental

Disabilities


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Acknowledgements

• This project was funded by the New Jersey Council on Developmental Disabilities

• We received assistance from the New Jersey Division of Developmental Disabilities (DDD) and the New Jersey Division of Medical Assistance and Health Services (Medicaid)


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Project Team

• Dorothy Gaboda• Thomas Trail• Igda Martinez• Susan Brownlee

Center for State Health Policy at Rutgers(CSHP)


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Background

• Many Medicaid beneficiaries have been in managed care in New Jersey and other states since the early 1990’s

• New Jersey Care 2000+ was implemented to provide managed care for SSI Aged, Blind and Disabled beneficiaries in October 2000

• Managed care has the potential to provide more coordinated care and enhance the quality, continuity, and appropriateness of care received


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Planning for New Jersey Care 2000+

• Extensive planning process which involved advocates, representatives of health plans, experts, and experiences in other states

• Managed care contract provides many protections for individuals with special needs

• Health plans are required to provide care management and a network of providers with expertise in dealing with individuals with special needs


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Implementation of New Jersey Care 2000+

• Original plan was to phase in new beneficiaries in four tiers by county

• Initial period of voluntary enrollment, followed by automatic assignment to an HMO

• Extensive outreach and education provided by Health Benefits Coordinators

• Automatic assignment only implemented in Camden County


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Purpose of the Study

• Examine how well the enrollment process into Medicaid managed care is working for people with developmental disabilities

• Look in-depth at problems people are having to help improve the process

• Learn about problem solving strategies


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Methods

• Mail survey of 325 people who enrolled between October 2000 and September 2002

• Survey was conducted November 2002-January 2003

• Follow-up personal interviews with 37 individuals


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What did we ask about?

• Enrollment materials• Assistance from

Health Benefits Coordinators (HBCs)

• Information from HMOs

• Primary Care doctors and specialists

• Prescription drugs• Care managers• Complex needs

assessments• Special services• Referrals outside

HMO network


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Who responded to the Survey?

• Very similar to other individuals served by DDD in age and gender (44% female)

• From all counties in New Jersey• 17% Hispanic, 18% Black/African American• Most surveys completed by proxy for the

consumer, usually parent or guardian• More living with families than in group

homes


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HMO Reported by Respondents

Horizon Mercy35%

AmeriChoice26%

Amerigroup16%

Health Net10%

University9%

No response4%


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HMO Enrollment• Nearly two-thirds (61%) of respondents said they

chose their own HMO.• 41% of those who picked their own plan chose

Horizon Mercy; 20% chose Amerigroup; 18% chose AmeriChoice.

• 13% picked Aetna originally; 62% of these changed to AmeriChoice.

• 14% indicated they were automatically assigned, but many of these made a choice after advice and assistance from a medical professional or a Health Benefits Coordinator.


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Findings about the Enrollment Process

• Outreach worked:– 80% received a kit and/or attended an enrollment

event• 82% said enrollment kit was easy to understand• 62% said it was easy to know where to get help• No differences by race or ethnicity• Those who had difficulty had problems finding

out which networks their doctors belonged to


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Selecting an HMO• 63% found it easy to select an HMO—very few

automatically assigned• People received help mostly from family and

guardians; some from their doctor, nurse, or social worker

• Most people (69%) picked HMO because they could keep their doctors

• 18% hoped to receive new services• Those who had difficulty selecting found process

and paperwork confusing or had competing family priorities


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Experience with Health Benefits Coordinators

• Nearly half of respondents got information or assistance from a Health Benefits Coordinator

• Over half reached an HBC after one or two calls; 70% had no difficulties

• 65% had questions about which network doctors or hospitals were in

• 83% were satisfied with response from HBC


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Experience with Doctors

• 70% kept previous doctor as Primary Care Provider; similar in all health plans

• Most people kept all or some previous specialists

• Nearly half were referred to new medical/dental specialists

• 85% said they could see their doctor as often as they wanted– About 10% who chose a new PCP had problems

seeing doctor


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Satisfaction with Doctors

• 95% were satisfied with Primary Care Provider• Only half had picked a dentist—85% of these

were satisfied– Inability to find a dentist was mentioned by 5% in

open-ended questions.• High satisfaction with travel time, time to get

appointments and service at offices• Those who were dissatisfied worried about

doctors dropping out of networks


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Mental Health/Substance Abuse Services

• Fewer than 30% reported needing mental health/substance abuse services – About ¾ got services they wanted

• 20% needed crisis services– 50% got services


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Care Managers

• Over half of respondents had a care manager

• Most got a care manager within one month• 84% were satisfied with their care

manager• Many said care manager was the best

thing about their HMO• Care managers helped get new services

and solve problems


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Comments About Care Managers

• “Special needs coordinator extremely helpful”

• “The special care coordinator took care of finding and arranging for a pediatric dentist”

• “Special needs case manager—she goes the extra mile to help my son”


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Awareness of Rights

41.5%

61.5%

74.5%

54.8%

56.3%

81.9%

0% 20% 40% 60% 80% 100%

Can enroll in HMO in any county

Can change to another HMO at any time

Can change PCP at any time

Can appeal if you cannot receive service

Can call Medicaid Managed Care hotline

Can call member services withquestions


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Satisfaction with HMO

• Asked respondents to rate overall satisfaction with HMO on 4 point scale (very unsatisfied to very satisfied)

• 63.1% of respondents said they were either satisfied or very satisfied with their HMO


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Rating of Overall Satisfaction with HMO (N=325)

18.5%

44.6%

11.4% 12.9% 12.6%

0%5%

10%15%20%25%30%35%40%45%50%

Verysatisfied

Satisfied Unsatisfied Veryunsatisfied

Don't Know


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Percent Satisfied with HMO

0%10%20%30%40%50%60%70%80%90%

Horizo

n Merc

y

Health

Net

Univers

ityAmeri

grou

pAmeri

Choice

Overal

l

• Horizon Mercy was significantly above average and AmeriChoice was significantly below average


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Open-Ended Questions

• Asked for specific comments on HMOs to supplement ratings– “What is the best part of being in your

HMO?”• N = 210

– “What is the worst part of being in your HMO?”

• N = 224


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The Best Part

• About half said:– Keeping the same primary care doctor– Keeping the same specialists– Having a care manager

• Other common responses were:– Having good doctors– Getting better service or coverage than had

previously


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The Best Part: Examples• “The best part is I have a real good doctor.”• “We were able to continue medical care with our

previous provider.”• “No out-of-pocket expense. Most specialists we

see are members.”• “Care management with their monthly follow up.”• “Availability of services, i.e. speech, OT,

counseling. However, would like to see bio feed- back and other alternative health services offered.”


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The Worst Part

• Over half said:– Number of doctors, specialists, and

hospitals who do not accept coverage or are not accepting new patients

• Other common responses:– Difficulty and inconvenience of getting

referrals– Difficulties getting name brand medications


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The Worst Part: Examples

• “I call doctor after doctor; they have dropped out.”

• “Unable to find a dermatologist, surgeon or dentist in or near our area willing to accept it. At best they make you wait 3-4 months for an appt.”

• “All the red tape you have to go through to get service.”


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Follow-up Interviews• Obtain more in-depth information about sources

of dissatisfaction and/or difficulties experienced• Selection criteria:

– Dissatisfied or experienced difficulties– Consumers, parents of young children, parents of

adult children, and community providers– Hispanic ethnicity

• 37 people were interviewed– 6 Hispanic, four interviews in Spanish– 7 Black/African American


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Interview Subject Areas

• Enrollment/Selecting an HMO• HMO Process/Paperwork• Primary Care Physicians and Specialists• Care Managers • Problem Solving Strategies


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Interview Findings:Enrollment/Selecting an HMO

• Many parents interviewed didn’t seem to have made an “informed” choice– Didn’t research physician networks or

services– Chose HMO they were told was “the best”

• Some felt forced to enroll in an HMO– Letters and phone contacts conveyed that

those who didn’t sign up voluntarily would be assigned an HMO


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Interview Findings:HMO Process/Paperwork

• Inconvenience of managed care was a major theme– Referral process and travel time to network

physicians and facilities– Especially an issue for working parents

• Products and services covered– Knowledge of coverage– Denials of claims


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Interview Findings:PCPs and Specialists

• The possibility of having to switch physicians is an enormous concern– Established network of specialists– Concern about availability of quality

physicians with experience treating people with special needs

• Perception that physicians they want to use will not stay in HMO networks


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Interview Findings:Care Managers

• Few had experience with care managers• Those who did found care managers

helpful in getting referrals and services• Difficulty getting a care manager• Turnover among care managers was a

problem


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Interview Findings:Problem Solving Strategies

• Call HMO or Health Benefits Coordinator• Care managers helpful• Call ARC or other advocacy group• Several parents stopped using benefits

– Cover child under parent’s plan– Pay out of pocket– Go without or delay care

• Staff from community providers seemed to navigate the system better than some parents


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Summary• Outreach was successful and many got help

enrolling from HBCs• Up-to-date information on provider networks is

key to satisfaction with enrollment• Satisfaction with doctors and specialists is

high—some perception that doctors are leaving HMO networks

• Satisfaction with care managers is high, and they appear key to problem solving

• Some parents are isolated and uninformed and would benefit from case management and education


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To obtain a copy of the full report

• Report:Transitions into New Jersey Care 2000+:

Experiences of Consumers with Developmental Disabilities and their Families

• Available on-line at www.cshp.rutgers.edu or www.njddc.org

• Call 609-984-4513 or fax 609-292-7114, ATTN: Pat Krupka

http://www.cshp.rutgers.edu/

http://www.njddc.org/

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