CHCF Host Briefing on SPD Transition

March 29, 2013

Yesterday, the California HealthCare Foundation hosted a briefing on the experience of seniors and persons with disabilities transitioning to Medi-Cal managed care plans. California’s 2010 §1115 Medicaid Waiver permitted the mandatory enrollment of SPDs into managed care beginning June 2011. The shift into managed care aims to help DHCS achieve better care coordination, improved management of chronic diseases, and better health outcomes.

The briefing provided information on UC Berkeley School of Public Health’s evaluation of the transition, which assessed beneficiaries’ experience with notifications, choice and enrollment, and access. Findings from the evaluation were gathered through telephone surveys and focus groups with input from a stakeholder advisory group and collaboration with DHCS’ Medi-Cal Managed Care Division. When asked about the usefulness of the notification packets on the transition, 33% of respondents found the packets very useful, 38% found them somewhat useful and 23% indicated the packets were not at all useful. Interestingly, when asked what questions were not answered in the notification packet, 39% of beneficiaries indicated the reason why the transition was occurring was not mentioned.

With the shift into managed care, SPDs were provided a selection of managed care plans to choose from. If beneficiaries failed to choose a plan, they were either defaulted to a health plan, or defaulted and linked to a health plan based on their provider history from fee-for-service data. Almost half of the respondents (46%) chose a plan, while 50% were assigned. While many beneficiaries were aware of their choices, a fair number did not make one, and reported that they didn’t have enough information and that the plans seemed the same.

When assessing continuity of care, 60% of respondents indicated that they were able to keep their PCP.

Similarly, 60% of respondents indicated that they were able to keep all of their specialists.

When examining lessons learned from the experiences of these beneficiaries, each of the following were clear:

  • Notices should explain why the transition is happening and include specific information about how the change will affect the care of the beneficiaries. It is also important that materials are written at the appropriate literacy level and that information about who to call for questions is clear.
  • Doctors, their offices and clinics are key venues for educating beneficiaries about changes and supporting them through the transition.
  • Managed care plans need to be strategic in helping beneficiaries navigate the system through phone calls and in-person support.

As eight California counties gear up for the Cal MediConnect demonstration for those dually-eligible for Medicare & Medicaid, and as the state gears up for Medi-Cal expansion, we all can find great value in these timely lessons from the SPD transition.

For other details on the evaluation, click here.