The impact of case management on the elderly in a managed care environment: Member understanding and plausible benefit.

摘要

The aim of this study was to explore the experiences of elderly, chronically ill, Medicare eligible health care consumers within a managed care system with regards to their knowledge of, and expectations for, case management. The study was conducted using a purposeful convenience sample of 15 participants who were chronically ill with heart failure and/or diabetes mellitus. Subjects were recruited from a local health maintenance organization with an enrollment of 20,000 Medicare-eligible members.; Focus groups were conducted to collect data regarding the subjects' knowledge of case management. Subjects were also asked what they identified as the role of the case manager within the managed care organization. A total of 3 focus groups were conducted before saturation was achieved. Content analysis was used to analyze the data.; Emerging themes were identified that included: (a) difficulty with understanding and interpreting the ongoing changes in health plan benefits; (b) displeasure with the quality of health plan benefits/services; and (c) a perceived disconnect in health care services and providers. Themes emerged that support previous research done by Paterson (2001), in which participants reported needing or expecting different services at different times based upon their illness perspective—whether the illness was foregrounding or backgrounding.; The study revealed that subjects have limited knowledge of the fact that case management is an available service within their health care organization. Further analyses revealed that subjects had little understanding of the role of a case manager.; In this group of patients in a managed care system, it is interesting that only 3 of the 15 subjects were aware of what a case manager is. The findings may prompt health care systems to determine the strategies needed to enhance treatment plan engagement of chronically ill elders across the continuum of care.