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Partnering managed care and community-based services for frail elders: the care advocate program.
Kathleen H Wilber1, Douglas Allen, George R Shannon
1Andrus Gerontology Center, University of Southern California, Los Angeles, California 90028, USA. Wilber@usc.edu
Journal of the American Geriatrics Society
|May 22, 2003
Summary
This demonstration program successfully linked Medicare managed care members to community services using care advocates. It highlighted the importance of trust-building and partnerships for improving member satisfaction and retention.
Area of Science:
- Gerontology and Aging Services
- Health Services Research
- Community Health
Background:
- Medicare managed care enrollees, particularly frail, high-cost users, often require support beyond traditional insured healthcare services.
- Existing case management models may not adequately address the need for home- and community-based services (HCBS).
- Bridging the gap between insured healthcare and community resources is crucial for comprehensive elder care.
Purpose of the Study:
- To evaluate a demonstration program utilizing master's-level care managers (care advocates) to connect Medicare managed care enrollees with HCBS.
- To determine if referrals to non-insured services can reduce overall service utilization.
- To assess the program's impact on member satisfaction and retention within the managed care plan.
Main Methods:
- A partnership was established between PacifiCare Secure Horizons, four medical groups, and two social service organizations.
- An algorithm identified frail, high-cost Medicare beneficiaries for targeted intervention.
- Three care advocates conducted telephone assessments and provided monthly follow-ups for 390 members (aged 69-96) over 12 months, linking them to eight types of HCBS.
Main Results:
- Key lessons emphasized the necessity of fostering a shared vision among collaborating partners.
- Leveraging existing member-provider relationships was vital for program success.
- Building trust through telephone interactions, without face-to-face contact, proved effective.
Conclusions:
- The care advocate program effectively complements existing insured case management services.
- It provides a viable pathway for Medicare managed care enrollees to access essential community-based services.
- The model demonstrates potential for improving care coordination and member outcomes.