While large managed-care companies have jumped into the Medicare risk business, most haven't developed a full range of programs for frail and chronically ill seniors, according to a recent study.
But some Medicare HMOs are well prepared for dealing with elderly populations, and many offer services that weren't available under traditional Medicare, the survey found.
The study was conducted in the summer and fall of 1997 by Abt Associates, a healthcare research and consulting company based in Cambridge, Mass., and Smith Phillips Strategic Communications, based in Maynard, Mass.
Respondents included 28 health plans enrolling 1.1 million Medicare beneficiaries, or about 25% of all Medicare risk enrollees, in 17 cities.
While most plans have developed one or more specialized services for seniors, no plan offers enrollees access to all the programs recommended by experts to care for chronically ill seniors, according to the study.
The survey measured whether the HMOs provided services for the frail elderly and chronically ill, including risk screening and assessment, self-care, cooperative team care, provider training, geriatric consultation, case management and tracking of utilization data.
Most surveyed plans had several of the recommended programs, but only 14% offered a broad range, the study said.
"The number and type of programs implemented vary widely across plans, within market areas and even from medical group to medical group within a plan in a particular market area," the study said. Because of this wide variation, seniors find it difficult to make the right choice of HMOs, said Terry Moore, a senior researcher for Abt.
"This doesn't mean that managed-care companies are doing a bad job. This is uncharted ground for these companies, and it takes time and data to determine" which programs work best, Moore said.
According to the American Association of Health Plans, 15.4% of Medicare beneficiaries are enrolled in HMOs. That number is expected to increase as a result of the federal government's effort to encourage the growth of managed care in the Medicare system.
Donald Young, M.D., the AAHP's senior vice president for clinical affairs, said the Abt survey shows that HMOs are moving to fill the needs of seniors. Under a grant from the Robert Wood Johnson Foundation, the AAHP is finding that plans are learning how to care for the chronically ill elderly.
"Some are further ahead than others, but that's not unexpected, particularly in light of the recent rapid growth of Medicare managed care," he said.
"The core of what the survey found is that since coordination of services hasn't been done under traditional fee-for-service Medicare, we're still learning how to do it."
The Abt survey results might be good news for some provider groups because Medicare managed-care companies might be "receptive to outsourcing services to organizations experienced with managing care for frail or chronically ill elders," Moore said.