FEE-FOR-SERVICE OR MANAGED CARE? INVESTIGATING DUAL ELIGIBLE CONSUMER PREFERENCES FOR HEALTH CARE

摘要

The CHOICE study investigated the preferences and decision-making behaviors of dual eligible health care consumers (i.e., those eligible for both Medicare and Medi-Cal) in Los Angeles California. Between April 2014 and March 2015, eligible consumers were enrolled into a managed care demonstration program called Cal MediConnect unless they actively opted out. Cal MediConnect is designed to integrate the financing and delivery of Medicare and Medi-Cal benefits and provide vulnerable consumers with better coordinated care. Yet uptake and retention of Cal MediConnect has fallen far below expectations. We conducted 48 in-depth interviews with consumers who either “opted out” or were enrolled in a Cal MediConnect plan. Using constant comparison analysis, we identified a complex set of factors that influenced consumer decision-making including: relationships with and access to providers; anxiety and confusion about health care options; and perceptions of health care quality. While consumers acknowledged that extra benefits offered through Cal MediConnect were attractive, many were willing to forgo these advantages in order to retain an existing and trusted network of care. Many who “opted out” also preferred to direct their own care and generally disliked the restrictions they associated with managed care. Case studies illustrate how consumers evaluated the options available to them and highlight differences by age, race/ethnicity, and level of disability. Understanding how individuals make health care decisions will help inform strategies for effectively communicating with and responding to the preferences of a diverse group of dual eligible health consumers and practices that better support health-related consumer decision making.