Care coordination experiences of people with disabilities enrolled in medicaid managed care.

TitleCare coordination experiences of people with disabilities enrolled in medicaid managed care.
Publication TypeJournal Article
AuthorsBowers A, Owen R, Heller T
JournalDisabil Rehabil
Date Published2016 Aug 22

PURPOSE: To understand the impact of experience and contacts with care coordinators on Medicaid Managed Care (MMC) enrollees with disabilities. METHOD: Primary data was collected from a random sample of 6000 out of the 100,000 people with disabilities enrolled in one state's mandatory MMC program. Surveys were conducted through the mail, telephone, and Internet; 1041 surveys were completed. The sample used for analysis included 442 MMC enrollees who received care coordination. Regression analyses were conducted with the outcomes of number of unmet health care needs and enrollee appraisal of the health services they received. Race, age, gender, and disability variables controlled for demographic differences, and the independent variables included enrollee experience with a care coordinator (coordinator knowledge of enrollee medical history and whether the coordinator took into account enrollee wishes and input) and frequency of contact with a care coordinator. RESULTS: Positive enrollee experiences with care coordinators significantly related to more positive enrollee health service appraisals and fewer unmet health care needs; frequency of contact did not have any significant impacts. People with mental health disabilities and intellectual/developmental disabilities had significantly lower health service appraisals. People with mental health disabilities had significantly more unmet needs. CONCLUSIONS: Quality of care coordination, but not frequency of contact alone, is associated with better health outcomes for MMC enrollees. Implications for rehabilitation Care coordination is a core component of managed care and facilitates effective healthcare management for people with complex chronic conditions and disabilities. Better experiences with care coordinators is related to fewer unmet healthcare needs and more positive health care service appraisals for Medicaid managed care enrollees. The continuous development of person-centered care coordination strategies and training programs emphasizing quality relationships between coordinators and consumers should be prioritized.

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What was this research about?

Recently, many Medicaid programs have begun following a “managed care” model for their coverage. This means that their healthcare is coordinated through a single managed care organization. Some Medicaid enrollees, especially those with more complex health needs, are assigned a care coordinator when they sign up for Medicaid. The care coordinator, like a case manager, works with the enrollee to develop a personalized healthcare plan and helps the enrollee access needed services. Care coordinators could be of great assistance to Medicaid enrollees with disabilities, who may have complex healthcare needs. In this study, we wanted to see if the quality and quantity of contact people with disabilities had with their care coordinator was related to their healthcare satisfaction or their unmet healthcare needs.

What did the researchers do?

Researchers at the University of Illinois at Chicago sent surveys to Medicaid enrollees with disabilities who were receiving managed care. The researchers focused on surveys from 442 respondents who had been assigned a care coordinator. The survey asked respondents to rate the quality and quantity of contact they had with their care coordinator. To measure quality, the respondents indicated how much their care coordinator knew about their personal medical history, how often the coordinator took their wishes into account when developing care plans, and how much input they had in their care planning. To measure quantity, the survey asked respondents how often their care coordinator called or visited them to follow up on their healthcare needs. Then, to find out how quality and quantity of contact was related to overall care satisfaction, the respondents answered survey questions about how satisfied they felt with their healthcare overall and specifically from their primary care doctor and specialists. The respondents also indicated if they had any “unmet needs”, or specialty services they needed but couldn’t get from their health plan. Finally, the respondents answered questions about their background and disability type.

What did the researchers find?

Overall, most respondents were happy with their care coordinators, and they felt that their coordinators understood their medical needs and took their wishes into consideration. Respondents who felt they had better-quality relationships with their care coordinators were happier with their healthcare and had fewer unmet needs than those respondents who reported less positive relationships. The frequency of coordinator contact, however, was unrelated to respondent satisfaction or unmet healthcare needs.

There were also differences between disability types: Respondents with intellectual/developmental and respondents with mental health disabilities were less satisfied with their healthcare than respondents with physical disabilities. Respondents with mental health disabilities reported having more unmet needs than those with intellectual/developmental or physical disabilities.

How can you use this research?

  • Care coordinators can provide “person-centered” care by building relationships with patients and valuing their wishes and input. When this happens, patients are more satisfied with their care, which can lead to better outcomes and lower costs.
  • Training in communication skills and disability-specific issues may help improve relationships between care coordinators and their patients with disabilities.
  • Although patients were happy in general with the services they received under Medicaid Managed Care, those with mental health and intellectual/developmental disabilities were less satisfied. Improving care for these disability groups, who may have more complicated healthcare needs, is an important area for Medicaid managed care programs to address.

Things you should know:

To learn about changes in Medicaid programs, go to:

To learn about your eligibility for benefit programs, including Medicaid, go to:

Original research article:

Bowers A, Owen R, Heller T. Care coordination experiences of people with disabilities enrolled in medicaid managed care. Disabil Rehabil. 2016; Aug 22:1-8.

PubMed ID27548093