Overall Findings from Cal MediConnect Rapid Cycle Polling Project 2018
This project conducted in various counties in California aimed to evaluate the experiences of beneficiaries enrolled in Cal MediConnect, comparing those in coordinated care to opt-outs and non-CMC counties. The surveys collected data via telephone interviews over multiple waves from 2015 to 2018, tracking confidence and satisfaction levels of participants. The findings provide insights into the impact of the Dual Financial Alignment Demonstration and the effectiveness of integrated health plan options.
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Overall Angeles Los 2018 Findings from the Cal MediConnect Rapid Cycle Polling Project Riverside Bernardino San Diego San Conducted for The SCAN Foundation Santa Clara In conjunction with The California Department of Health Care Services Mateo San By Institute for Health and Aging, University of California, San Francisco Orange September 2018
Overall California s Dual Financial Alignment Demonstration Cal MediConnect Angeles Los Riverside Background: In 2014, California implemented a dual financial alignment demonstration called the Coordinated Care Initiative. Part of the demonstration Cal MediConnect (CMC), created integrated health plan options in seven counties for people eligible for both Medicare and Medi-Cal. Bernardino San Beneficiaries enrolled in Cal MediConnect had all of their medical care, ancillary services and long-term services and supports (LTSS) coordinated through one integrated managed care plan. Diego San Cal MediConnect beneficiaries received some new benefits such as care coordination and non-emergency transportation. Santa Clara Approximately half of eligible beneficiaries opted out of the program and kept their original Medicare. Those who opted out were still enrolled in Medi-Cal managed care plans for their long-term services and supports. Mateo San Orange 1
Overall Survey Objectives Angeles Los Riverside Objectives: To evaluate and track over time the experiences of dually eligible beneficiaries enrolled in coordinated care under CMC, compared to those who opted out and those in non-CMC counties. Bernardino San Assess the confidence and satisfaction of CMC enrollees with the health services they are receiving. Diego Compare CMC enrollees level of confidence and satisfaction with beneficiaries who chose to opt out of CMC or who live in non-CMC counties. San Santa Clara Identify how CMC beneficiaries confidence and satisfaction changes over time. Mateo San Orange 2
Overall About the Surveys (1) Angeles Los Survey method Riverside Telephone interviews with stratified random samples of dual eligible beneficiaries in Cal MediConnect (CMC) counties, as well as beneficiaries in 9 non-CMC counties Bernardino San Data collection periods 2015 (includes Wave 1 in September; and Wave 2 in November) Diego San 2016 (includes Wave 3 in April; and Wave 4 in September) 2017 (includes Wave 5 in August) Santa Clara 2018 (includes Wave 6 in May) Populations surveyed Mateo 2015: CMC enrollees and opt-outs in 5 counties (Los Angeles, Riverside, San Bernardino, San Diego, and Santa Clara), and two non-CMC counties (Alameda and San Francisco) San 2016 through 2018: CMC counties were expanded to two additional counties (San Mateo and Orange) Orange 2017 and 2018: Non-CCI counties were expanded to include a total of 9 non-CMC counties 3
Overall About the Surveys (2) Angeles Los Sample Sizes by Survey Year 2018: 2,961 interviews, including 1,775 CMC enrollees, 781 CMC opt-outs, and 405 beneficiaries in non-CMC counties. 2017: 2,984 interviews, including 1,781 CMC enrollees, 786 CMC opt-outs, and 417 beneficiaries in non-CMC counties. 2016: 6,513 interviews, including 3,351 CMC enrollees, 2,031 CMC opt-outs, and 1,131 beneficiaries in non-CMC counties. 2015: 5,002 interviews, including 2,764 CMC enrollees, 1,368 CMC opt-outs, and 870 beneficiaries in non-CMC counties. Riverside Bernardino San Diego San Santa Clara Mateo San Aggregate Sample Sizes (across all years) 9,671 CMC Enrollees 4,966 CMC Opt-Outs 2,823 non-CMC counties Orange 4
Overall Angeles Los Riverside Bernardino San Findings in Brief Diego San Santa Clara Mateo San Orange 5
Findings in Brief Overall Angeles Confidence Navigating Health Care Los Riverside Large majorities of CMC enrollees continue to express confidence that they know how to manage their health conditions (82%), that they can get questions about their health needs answered (84%), and know who to call if they have a health need or question (89%). Bernardino San While confidence ratings in earlier years had been similar across enrollees and opt-outs, starting in 2017 and continuing in 2018 CMC enrollees confidence was higher in all three areas than the other groups. Diego San Santa Clara CMC enrollees confidence in these areas has progressively increased between 2015 and 2018; while confidence among opt-outs has remained steady. Mateo San Orange 6
Findings in Brief Overall Angeles Satisfaction with Health Care Services Los Riverside Large majorities of CMC enrollees ranging from 77% to 89% report being satisfied with the health care services they are receiving in each of 7 areas tracked. Bernardino San The satisfaction levels of CMC enrollees increased between 2015 and 2018 in all seven areas. Diego San In 2018, CMC enrollees were more satisfied than opt-outs in the areas of: Santa Clara the information they get from their health plan explaining benefits, the way different providers work together, and Mateo San their ability to call a provider regardless of the time of day. While in past years those who opted out were more satisfied than CMC enrollees with the amount of time spent with their doctor, by 2017 satisfaction increased to match opt outs. Orange 7
Findings in Brief Overall Angeles Problems Encountered with Health Care Los Riverside In 2018, the two most commonly reported problems among CMC enrollees were: a doctor they had been seeing was no longer available through their plan (16%), and they had a misunderstanding about their health care services or coverage (14%). Bernardino San Diego San CMC enrollees in 2018 had lower rates of reported problems than in previous years in three areas: Santa Clara Had a misunderstanding about health care services or coverage (21% in 2015 down to down to 14% in 2018). Mateo Health Plan denied treatment or referral for a service recommended by a doctor (17% in 2015 down to 13% in 2018). San Orange A doctor they had been seeing was no longer available through their plan (23% in 2015 down to 16% in 2018). 8
Findings in Brief Overall Angeles Length of Time with a Personal Doctor Los Riverside The percentage of both CMC enrollees that report they have been seeing their personal doctor* for a short time (1 year or less) declined significantly over the years, from 30% in 2015, down to 16% in 2018. Bernardino San Only 14% of opt-out beneficiaries reported that they had been seeing their personal doctor for 1 year or less, lower than CMC enrollees (16%) and non-CCI beneficiaries (22%). Diego San In 2018, 22% of duals in non-CCI counties had a short (1 year or less) relationship with their doctor, this is up from 12% in 2015 and is significantly more than both CMC enrollees (16%) and opt outs (14%). Santa Clara Mateo San Orange * A personal doctor was defined in the survey as the doctor who knows you best and can refer you to other doctors when you need to see a specialist. 9
Findings in Brief Overall Reported Use of Single Care Managers and Personal Care Plans by Enrollees and Opt-outs Angeles Los Riverside The percent of CMC enrollees who reported having a single care manager and/or a personal care plan decreased from one-third in 2016 down to one quarter in 2018. The proportion of opt-outs and non-CCI duals who reported having a single care manager decreased even more, from 33% in 2016 to 20% in 2018, and 36% in 2016 to 20% in 2018, respectively. Bernardino San Diego San Over half of CMC enrollees (57%) with single care managers in 2018 said that having such a manager has improved their care a lot. While more opt-outs with a single care manager (63%) and non-CCI duals (71%) reported the same. Santa Clara Almost three-quarters of CMC enrollees (65%) and opt outs (68%) with a personal care plan said it improved their care a lot, compared to less than half (48%) of non-CCI dual who reported the same. Mateo San Orange * A single care manager was defined in the survey as a nurse or other helper from their health plan who serves as their main point of contact and can arrange all aspects of their care. ** A personal care plan was defined in the survey as a plan designed to take into account their health goals, needs and preferences. 10
Findings in Brief Overall Health Status and Disability of CMC Enrollees and Opt- Outs Angeles Los Riverside Similar to past years, in 2018 a slightly higher proportion of opt-outs and non- CCI respondents (48%) reported they were in fair or poor health compared to CMC, of whom (43%) reported fair or poor health. Bernardino San A slightly larger percent of opt-outs (28%) than CMC enrollees (20%) say they have been in a hospital overnight in the past 12 months. Diego San Among opt-outs, 44% of LTSS beneficiaries reported they need assistance for common daily activities. This compares to 31% among CMC enrollees. Santa Clara More opt-outs (53%) than CMC enrollees (43%) also report using specialized equipment, such as a cane, wheelchair, scooter, or special bed. Mateo San Orange 11
Findings in Brief Overall Angeles LTSS Needs and Use of In-Home Supportive Services Los Riverside In 2017 and 2018, LTSS beneficiaries in all three groups were asked about their needs for LTSS and use of In-Home Supportive Services (IHSS), California s consumer directed personal assistance program. Bernardino San CMC enrollees report the lowest rates of needing help with personal care* (51%) compared to opt-outs (64%) and non-CMC beneficiaries (55%). Diego San Of those who reported needing help, about 4 in 10 beneficiaries in all groups had unmet needs for personal or routine care. Santa Clara Slightly more CMC enrollees and opt-outs with disabilities reported receiving IHSS (88% and 91%) in 2018 compared to non-CMC counties, where 84% of LTSS beneficiaries received IHSS. Mateo San 28% of CMC enrollees using IHSS said that their CMC plan helped them enroll or advocate for more hours. Orange * Personal care needs defined as: eating, bathing, dressing, or getting around inside the home. ** Routine needs defined as: everyday household chores, doing necessary business, shopping or getting around for other purposes 12
Findings in Brief Overall Angeles Characteristics of CMC Enrollees & Opt-outs Los Riverside Both CMC enrollees and opt-outs have very low levels of educational attainment, with 46% of CMC enrollees and 44% of opt-outs who did not graduate high school. Approximately one-fifth of CMC enrollees and opt- outs have a high school diploma. Bernardino San Large majorities of both enrollees and opt-outs are people of color, with Latinos comprising the largest segment of both groups, accounting for 47% of CMC enrollees and 41% of opt-outs. Less than 20% of CMC enrollees and opt-outs are white non-Hispanic, while 34% of duals in non-CCI counties were white non-Hispanic. Diego San Santa Clara Age varied across groups, with a larger percent (22%) of CMC enrollees under age 65, compared to only 20% of opt-outs. Mateo San While both groups are majority female, opt-outs have a higher distribution of females (63%). Orange Among all groups, about a quarter live alone. 13
Overall Overall Los Angeles Angeles Los RiversideRiverside San Bernardino Bernardino San Overall Findings Across the Four Survey Years San Diego Diego San Santa Clara Santa Clara San Mateo Mateo San Orange Orange 14
Overall Overall Findings Overall Los Angeles Angeles 1. Beneficiary Confidence Navigating Health Care Los RiversideRiverside Very large majorities of CMC enrollees in 2018 continue to express confidence that they know how to manage their health conditions (82%), can get questions about their health needs answered (84%), and know who to call if they have a health need or question (89%). San Bernardino Bernardino San San Diego In 2018, CMC enrollees confidence in these areas was slightly higher than opt- outs. Diego San Santa Clara Furthermore, CMC enrollees confidence in these areas has progressively increased between 2015 and 2018; while confidence among opt-outs has remained steady. Santa Clara San Mateo Mateo San Orange Orange 15
Overall Overall Findings Overall Table 1 Los Angeles Angeles Beneficiary Confidence Navigating Health Care Los RiversideRiverside CMC enrollees CMC opt-outs Non-CMC counties San Bernardino Bernardino 80% 83% 82% 2018 San Know how to manage your health conditions (% very & somewhat confident) 79% 82% 82% 89% 84% 2017 80% 2016 San Diego 79% 2015 80% 78% Diego San 84% 2018 83% 84% Can get questions about your health needs answered (% very & somewhat confident) Santa Clara 83% 2017 79% 81% 82% 85% 86% 77% Santa Clara 81% 2016 79% 2015 San Mateo Mateo San 85% 83% 89% 2018 Know who to call if you have a health need or question (% yes) 88% 83% 87% 2017 Orange 85% 2016 84% 78% 84% 84% Orange 81% 2015 16
Overall Overall Findings Overall Los Angeles Angeles 2. Satisfaction with Health Care Services Los RiversideRiverside Large majorities of CMC enrollees in 2018 ranging from 77% to 89% report being satisfied with the health services they are receiving in each of 7 areas. San Bernardino Bernardino San Satisfaction levels expressed by CMC enrollees have steadily improved over time in each of the 7 areas. San Diego Diego San In 2018, CMC enrollees were more satisfied than opt-outs in the areas of: the information they got from their health plan explaining benefits, Santa Clara Santa Clara the way different providers work together, and San Mateo their ability to call a provider regardless of the time of day. Mateo San In 2018, those who opted out were more satisfied than CMC enrollees with their choice of hospital. Orange Orange 17
Overall Overall Findings Overall Table 2 Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs Non-CMC counties San Bernardino Bernardino 89% 2018 89% 88% Amount of time doctor/other staff spend with you (% very or somewhat satisfied) San 88% 2017 86% 82% 86% 2016 89% 88% 87% 83% 84% 2015 San Diego Diego San 85% 2018 Information health plan gives explaining your benefits (% very or somewhat satisfied) 79% 82% 83% 2017 74% 77% 82% 2016 82% 78% Santa Clara 75% 2015 77% 69% Santa Clara 87% 83% 86% 2018 84% 87% 86% 84% Your choice of doctors (% very or somewhat satisfied) 83% 2017 San Mateo 83% 2016 Mateo San 78% 2015 85% 80% 83% 80% 79% 2018 Orange Your choice of hospitals (% very or somewhat satisfied) 79% 83% 84% 81% 82% 79% 79% 2017 Orange 79% 2016 78% 2015 18
Overall Overall Findings Overall Table 2 Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs Non-CMC counties San Bernardino Bernardino 82% 83% 84% 2018 San The way different providers work together (% very and somewhat satisfied) 80% 80% 83% 2017 82% 85% 84% 2016 San Diego 78% 2015 81% 80% Diego San 82% 77% 79% 2018 How long you have to wait to see a doctor when you need an appointment (% very and somewhat satisfied) Santa Clara 78% 78% 78% 2017 Santa Clara 81% 78% 80% 70% 77% 2016 74% 2015 San Mateo Mateo San 75% 76% 77% 2018 Your ability to call a health provider regardless of the time of day (% very and somewhat satisfied) 78% 2017 67% 74% Orange 75% 2016 76% N/A 73% N/A Orange N/A 2015 Note: N/A indicates the question was not asked in Year 1. 19
Overall Overall Findings Overall Los Angeles Angeles 3. Specific Problems with Health Care Services Los RiversideRiverside In 2018, no single problem was reported by more than 16% of CMC enrollees. The two most commonly reported problems encountered by CMC enrollees were that a doctor they had been seeing was no longer available through their plan (16%), and that they had a misunderstanding about their health care services or coverage (14%). San Bernardino Bernardino San San Diego In 3 areas, CMC enrollees in 2018 had lower rates of reported problems than they had in previous years, including: Diego San a doctor they had been seeing was no longer available through their plan (23% in 2015 down to 16% in 2018) Santa Clara Santa Clara denied treatment or referral for a service recommended by a doctor (17% in 2015 down to 13% in 2018) San Mateo Mateo San having a misunderstanding about health care coverage (21% in 2015 down to 14% in 2018) Orange CMC enrollees were slightly less likely than opt-outs to have trouble in the areas of transportation problems keeping them from getting needed health care and having a misunderstanding about health care coverage. Orange Opt-outs were slightly less likely than CMC enrollees to report that they had a treatment or referral denied, and the doctor they were seeing was not available their their plan. 20
Overall Overall Findings Overall Table 3 Los Angeles Angeles Specific Problems with Health Care Services (1) Los RiversideRiverside CMC enrollees CMC opt-outs Non-CMC counties San Bernardino Bernardino 16% 2018 13% 17% San A doctor you were seeing is not available through your plan 18% 2017 18% 18% 19% 2016 16% 17% San Diego 23% 2015 20% 14% Diego San 17% 19% 14% 2018 Santa Clara Had a misunderstanding about your health care services or coverage 21% 20% 19% 2017 Santa Clara 19% 24% 23% 20% 17% 2016 21% 2015 San Mateo Mateo San 10% 13% 13% 2018 Was denied a treatment or referral for another service recommended by a doctor 14% 13% 16% 2017 Orange 15% 2016 14% 16% 16% 19% Orange 17% 2015 21
Overall Overall Findings Overall Table 3 Los Angeles Angeles Specific Problems with Health Care Services (2) Los RiversideRiverside CMC enrollees CMC opt-outs Non-CMC counties San Bernardino Bernardino 15% 17% 12% 2018 Transportation problems kept you from getting needed health care San 13% 15% 16% 2017 12% 2016 15% 17% San Diego 14% 2015 16% 15% Diego San 10% 16% Had trouble communicating with a health provider because of a speech, hearing or other disability 10% 2018 Santa Clara 7% 15% 10% 2017 Santa Clara 11% 13% 13% 17% 10% 2016 12% 2015 San Mateo Mateo San 15% 12% 14% 2018 Health provider did not speak your language and no interpreter was available (among non- English speakers) 13% 2017 11% 18% Orange 10% 2016 9% 12% 9% 21% Orange 13% 2015 22
Overall Findings Overall 4. Length of Time Beneficiaries Have Been Going to their Personal Doctor Angeles Los Riverside The proportions of both CMC enrollees and opt-outs that report they have been seeing their personal doctor* for 1 year or less has declined significantly over the years. 2017 was the first year that the percent of CMC enrollees having a doctor for 1 year or less has been lower than non-CCI counties, and this trend continued in 2018. Bernardino San Diego San Only 14% of opt-out beneficiaries and 16% of CMC enrollees reported that they had been seeing their personal doctor for a short period (1 year or less), lower than non-CCI beneficiaries (22%). Santa Clara CMC enrollees that report having been with their personal doctor for 2 or more years increased from 69% in 2015 to 83% in 2018. Mateo San Orange * A personal doctor was defined in the survey as the doctor who knows you best and can refer you to other doctors when you need to see a specialist. 23
Overall Findings Overall Length of Time Beneficiaries Have Been Going to the Doctor They Consider their Personal Doctor Angeles Los Riverside CMC enrollees CMC opt-outs Non-CMC counties Bernardino 16% 2018 14% 22% 19% 2017 San 12% 24% 1 year or less 23% 2016 14% 20% 19% 12% 30% 2015 Diego 28% 34% San 37% 2018 29% 44% 41% 2017 2-5 years 39% 35% 39% 2016 35% 2015 33% 34% Santa Clara 23% 2018 27% 20% 22% 2017 27% 18% 6-10 years 23% 2016 27% 25% Mateo San 21% 24% 35% 2015 31% 24% 23% 2018 32% 15% 18% 2017 Orange More than 10 years 19% 22% 20% 19% 15% 2016 13% 2015 Note: Asked only of beneficiaries who report having a personal doctor. Differences between 100% and the sum of the percentages for each group equal proportion who could not give an estimate. 24
Overall Findings Overall 5. Beneficiaries Experiences with Single Care Managers Angeles Los Riverside Only a quarter of CMC enrollees in 2018 reported that they had a single care manager,* such as a nurse or other helper from their health plan, who serves as their main point of contact and arranges all aspects of their care. Bernardino San The proportion of CMC enrollees and opt-outs who reported having a single care manager declined, from about a third in 2016 to about a quarter in 2018. Diego San Over half (57%) of CMC enrollees and (63%) opt-outs with single care managers in 2018 said that having such a manager has improved their care a lot. Santa Clara Mateo San Orange * Single care manager described as the person who serves as your main point of contact and arranges all aspects of your care. 25
Overall Findings Overall Beneficiaries Who Report Having a Single Care Manager and Its Perceived Impact on Quality of Care Angeles Los Riverside CMC CMC Non-CMC opt-outs enrollees counties Bernardino San 2016 2017 2018 2016201720182016 2017 2018 Has a single care manager* 33%32% 24%33%27%20%36%31%20% Diego San If yes, has improved care A lot 63 64 57 65 71 63 68 70 71 Santa Clara A little 20 18 21 19 14 19 17 11 17 Not at all 7 9 11 7 6 8 8 12 1 Mateo San Not reported 9 9 11 9 9 10 7 7 12 Orange * Single care manager described as the person who serves as your main point of contact and arranges all aspects of your care. Note: Question not asked in 2015. 26
Overall Findings Overall Angeles 6. Beneficiaries Experiences with a Personal Care Plan Los Riverside A quarter of CMC enrollees reported in 2018 that they have a personal care plan* that takes into account their health goals, needs and preferences. This is significantly lower than the 33% reported in 2016. This proportion decreased significantly in all three groups. Bernardino San Nearly two-thirds (65%) of CMC enrollees with a personal care plan said that having a personal care plan improved their care a lot. This is similar to opt outs (68%), but significantly higher than non-CMC duals, of whom 48% said the personal care plan improved their care a lot. Diego San Santa Clara Mateo San Orange * Personal care plan described as a plan designed to take into account your health goals, needs and preferences. 27
Overall Findings Overall Beneficiaries Who Report Having a Personal Care Plan and Its Perceived Impact on the Quality of Their Care Angeles Los Riverside CMC CMC Non-CMC opt-outs enrollees counties Bernardino San 2016 2017 2018 2016201720182016 2017 2018 Has a personal care plan* 33%32% 26%36%27%23%41%36%24% Diego San If yes, it has improved care A lot 64 68 65 70 62 68 63 62 48 Santa Clara A little 22 18 23 18 16 19 24 22 31 Not at all 7 6 5 6 9 5 7 7 6 Mateo San Not reported 7 8 7 6 13 8 6 3 15 Orange * Personal care plan described as a plan designed to take into account your health goals, needs and preferences. Note: Question not asked in 2015. 28
Overall Overall Findings Overall Los Angeles 7. Demographic Characteristics of Enrollees and Opt-outs Across the Seven CMC Counties (1) Angeles Los RiversideRiverside The following are the demographic characteristics of each group combined across all 4 years of the survey: San Bernardino Bernardino San Majorities of both enrollees and opt-outs are women, although women constitute a slightly larger proportion of opt-outs (63%) than CMC enrollees (57%). San Diego Diego San A large majority of both CMC enrollees and opt-outs are people of color. For example, among enrollees 47% are Latino, 13% are Asian American and 10% are African American, while just 19% are white non-Hispanic. The distributions are similar among opt-outs with 41% Latino, 16% Asian American and 13% African American. Only 18% of opt-outs are white non- Hispanic. Santa Clara Santa Clara San Mateo Mateo San Orange About 78% of enrollees and 81% opt-outs are age 65 or older. Among those over 65, a greater proportion of opt-outs are 75 and older (39%) compared to CMC enrollees (49%). Orange 29
Overall Overall Findings Overall Los Angeles Comparing the Demographic Characteristics of Enrollees and Opt-outs in CMC Counties (1) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino Gender San Male 43% 37% Female 57% 63% San Diego Age Diego San Under 65 22% 20% 65-74 38% 32% Santa Clara Santa 75 or older Clara 39% 49% Race/ethnicity San Mateo White non-Hispanic 19% 18% Mateo San Latino 47% 41% African American 10% 13% Orange Asian American 13% 16% Orange Other/not reported 11% 11% Note: Percentages shown are the combined totals for enrollees and opt-outs in CMC counties across all survey waves. 30
Overall Overall Findings Overall Los Angeles Demographic Characteristics of Enrollees and Opt-outs in CMC Counties (2) Angeles Los RiversideRiverside Among both CMC enrollees and opt-outs, almost half have not graduated from high school, while another one in five have no more than a high school degree. Very few 9% of enrollees and 10% of opt-outs are college graduates. San Bernardino Bernardino San San Diego About six in ten CMC enrollees (60%) and opt-outs (59%) report receiving Supplemental Security Income/Payment or other support from the federal government. Diego San Santa Clara Santa Clara San Mateo Mateo San Orange Orange 31
Overall Overall Findings Overall Los Angeles Comparing the Demographic Characteristics of Enrollees and Opt-outs in CMC Counties (2) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino Education San Not a high school graduate 44% 46% San Diego High school graduate 20% 19% Diego San Some college/trade school 14% 13% Santa Clara College graduate 9% 10% Santa Clara Receive Supplemental Security Income/Payment San Mateo Mateo San Yes 60% 59% No 30% 36% Orange Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 32
Overall Overall Findings Overall Los Angeles 8. Health-status and Disability of CMC Enrollees and Opt-outs Angeles Los RiversideRiverside Opt-outs report more disability, and more acute care utilization than those enrolled in CMC. San Bernardino Bernardino San Slightly more opt-outs (48%) rated their own health as fair or poor, compared to 43% of CMC enrollees. San Diego Diego San Among opt-outs 44% are LTSS beneficiaries who require assistance for common daily activities. This compares to 31% among CMC enrollees. Santa Clara Santa Clara More opt-outs (53%) than enrollees (43%) also report using specialized equipment, such as a cane, wheelchair, scooter or special bed. San Mateo Mateo A slightly larger proportion of opt-outs (28%) than enrollees (20%) say they have been an overnight patient in a hospital in the past 12 months. San Orange Orange 33
Overall Overall Findings Overall Los Angeles Angeles Comparing Health and Disability Status Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino San In fair or poor health 48% 43% San Diego Diego San Use specialized equipment, such as a cane, wheelchair, scooter or special bed 53% 43% Santa Clara Santa Clara Require assistance for common daily activities* 44% 31% San Mateo Mateo San Overnight patient in a hospital past 12 months 28% 20% Orange Orange * Common daily activities are defined as bathing, dressing, help with prepared meals, help doing housework, or grocery shopping. 34
Overall Findings Overall Angeles 9. Disability and Use of In-Home Supportive Services Los Riverside In 2017 and 2018, LTSS beneficiaries in all three groups were asked about their LTSS needs and use of In-Home Supportive Services (IHSS), California s consumer directed personal assistance program. Bernardino San CMC enrollees have lower rates of reporting needing help with personal care* (51%) compared to opt-outs (64%) and non-CMC beneficiaries (55%). Diego San Of those who reported needing help, about 4 in 10 beneficiaries in all groups had unmet needs for personal or routine care. Santa Clara Similar percentages of all duals with disabilities reported receiving IHSS (CMC 88%; opt out 91%, and non-CCI 84%) in 2018. Mateo San Orange * Personal care needs defined as: eating, bathing, dressing, or getting around inside the home. ** Routine needs defined as: everyday household chores, doing necessary business, shopping or getting around for other purposes 35
Overall Findings Overall Angeles LTSS Needs and Use of IHSS in 2018 Los Riverside Bernardino CMC enrollees CMC opt-outs counties Non-CMC San Needs help with personal care needs 51% 64% 55% Diego San Needs help with routine needs 78% 83% 77% LTSS beneficiaries currently using IHSS* 88%# 91%# 84%# Santa Clara Average number IHSS hours/month 90 103 95 Mateo San Unmet need for personal or routine care 40% 41% 39% Orange The question about IHSS was only asked if the beneficiary responded yes that they needed assistance with personal care and/or assistance with routine needs # The percentages reflect the fraction of people who need help with personal or routine care who are using IHSS 36
Overall Overall Los Angeles Angeles Los RiversideRiverside San Bernardino Bernardino Los Angeles County: Aggregated Results from Years 1-4 San San Diego Diego San Santa Clara Santa Clara San Mateo Mateo San Orange Orange 37
Overall Los Angeles County Overall Los Angeles 1. Beneficiary Confidence Navigating Health Care in Los Angeles County Angeles Los RiversideRiverside Both CMC enrollees and opt-outs in Los Angeles County express similar high levels of confidence that they know how to manage their health conditions, can get questions about their health needs answered and know who to call if they have a health need or question. In each area, about eight in ten of both Los Angeles County enrollees and opt-outs express confidence in their ability to manage their condition. San Bernardino Bernardino San San Diego Diego San Santa Clara Santa Clara San Mateo Mateo San Orange Orange 38
Overall Los Angeles County Overall Table LA-1 Los Angeles Beneficiary Confidence Navigating Health Care in Los Angeles County Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino Know how to manage your health conditions (% confident) San 80% 79% San Diego Diego San Can get questions about your health needs answered (% confident) 80% 80% Santa Clara Santa Clara Know who to call if you have a health need or question (% yes) 85% 84% San Mateo Mateo San Orange Orange 39
Overall Los Angeles County Overall Los Angeles 2. Satisfaction with Health Care Services in Los Angeles County Angeles Los RiversideRiverside Large majorities of CMC enrollees in Los Angeles County (between 77% and 87%) say they are satisfied with the health care services they are receiving in each of seven areas measured. CMC enrollees were more likely to be satisfied with their ability to call a health care provider regardless of the time of day (77% CMC vs.73% opt-outs). Slightly more CMC opt-outs than enrollees are satisfied in five areas. These include: San Bernardino Bernardino San San Diego Diego San Amount of time doctor/other staff spend with you (87% among enrollees vs. 89% among opt-outs) Santa Clara Santa Clara Choice of doctors (83% vs. 87%) San Mateo Mateo San Choice of hospitals (77% vs. 82%) The way different providers work together (81% vs. 83%) Orange Orange Wait time to see a doctor when you need an appointment (78% vs. 81%). 40
Overall Los Angeles County Overall Table LA-2 Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino Amount of time doctor/ other staff spend with you (% satisfied) San 89% 87% San Diego Diego San Information health plan gives explaining your benefits (% satisfied) 78% 81% Santa Clara Santa Clara Your choice of doctors (% satisfied) 87% 83% San Mateo Mateo San Your choice of hospitals (% satisfied) 77% 82% Orange Orange 41
Overall Los Angeles County Overall Table LA-2 Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino The way different providers work together (% satisfied) San 81% 83% San Diego Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) San 78% 81% Santa Clara Santa Clara Your ability to call a health provider regardless of the time of day* (% satisfied) 77% 73% San Mateo Mateo San Orange Orange * Asked only in Year 2 through 4. 42
Overall Los Angeles County Overall Los Angeles 3. Specific Problems with Health Care Services in Los Angeles County Angeles Los RiversideRiverside Relatively small proportions of enrollees and opt-outs in Los Angeles County say they encountered any of six specific problems relating to their health services in the recent past. San Bernardino Bernardino San The two most frequently mentioned problems, reported by less than 20% of both groups, are that a doctor they were seeing is not available through their plan or they had a misunderstanding about their health care services or coverage. San Diego Diego San Santa Clara Santa Clara When comparing the incidence of problems reported by enrollees to those of opt-outs, enrollees are somewhat more likely to report that a doctor they were seeing is not available through their plan. San Mateo Mateo San Orange Orange 43
Overall Los Angeles County Overall Table LA-3 Los Angeles Specific Problems with Health Care Services in Los Angeles County Angeles Los RiversideRiverside CMC enrollees CMC opt-outs A doctor you were seeing is not available through your plan San Bernardino Bernardino 19% 15% San Had a misunderstanding about your health care services or coverage San Diego 17% 20% Diego San Was denied a treatment or referral for another service recommended by a doctor 13% 12% Santa Clara Santa Clara Transportation problems kept you from getting needed health care 12% 14% San Mateo Mateo Had trouble communicating with a health provider because of a speech, hearing or other disability San 9% 10% Orange Health provider did not speak your language and no interpreter was available (among non- English speakers) Orange 11% 11% 44
Overall Los Angeles County Overall Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in Los Angeles County Angeles Los RiversideRiverside Over half of CMC enrollees in Los Angeles County are Latino (55%), a larger proportion than is found in the opt-out population (46%). San Bernardino Bernardino San Women comprise a somewhat larger share of the opt-out population in Los Angeles County (62%) than they do of CMC enrollees (55%). San Diego Diego San Less than 25% of both enrollees and opt-outs in Los Angeles County are under age 65, while over three-quarters are age 65 or older. Santa Clara Santa Clara A large percentage of both CMC enrollees (49%) and opt-outs (45%) in Los Angeles County have not graduated from high school. Very small proportions are college graduates 9% among enrollees and 13% among opt-outs. San Mateo Mateo San Greater than six in ten of CMC enrollees (62%) and opt-outs (63%) in the county say they receive Supplemental Security Income/Payment from the federal government. Orange Orange 45
Overall Los Angeles County Overall Table LA-4 Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino Gender San Male 45% 38% Female 55% 62% San Diego Age Diego San Under 65 25% 23% 65-74 42% 36% Santa Clara Santa Clara 75 or older 33% 42% Race/ethnicity San Mateo White non-Hispanic 14% 17% Mateo San Latino 55% 46% African American 15% 15% Orange Asian American 8% 13% Orange Other/not reported 7% 8% 46
Overall Los Angeles County Overall Table LA-4 Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino Education San 45% Not a high school graduate 49% San Diego 18% High school graduate 20% Diego San 18% Some college/trade school 17% Santa Clara 13% College graduate 9% Santa Clara Receive Supplemental Security Income/Payment San Mateo Mateo 63% Yes 62% San 27% No 29% Orange Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 47
Overall Los Angeles County Overall Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in Los Angeles County Angeles Los RiversideRiverside A somewhat smaller proportion of CMC enrollees (23%) than beneficiaries who opted out in Los Angeles County (30%) say they were an overnight patient in the hospital in the past year. San Bernardino Bernardino San This is noteworthy, especially since differences observed in the self-reported health status of the two populations in the county report being in fair or poor physical health at similar percentages: CMC enrollees (48%) and opt-outs (51%). San Diego Diego San Santa Clara However, a slightly larger proportion of opt-outs (51%) than enrollees (44%) does report using specialized equipment, such as a cane, wheelchair, scooter or special bed or report requiring assistance for common daily activities (46% vs. 36%). Santa Clara San Mateo Mateo San Orange Orange 48
Overall Los Angeles County Overall Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs Angeles Los RiversideRiverside CMC enrollees CMC opt-outs San Bernardino Bernardino San In fair or poor health 48% 51% San Diego Diego San Use specialized equipment, such as a cane, wheelchair, scooter or special bed 44% 51% Santa Clara Santa Clara Require assistance for common daily activities 36% 46% San Mateo Mateo San Overnight patient in a hospital past 12 months 23% 30% Orange Orange 49
