Partnering managed care and community-based services for frail elders: the care advocate program

J Am Geriatr Soc. 2003 Jun;51(6):807-12. doi: 10.1046/j.1365-2389.2003.51257.x.

Abstract

Objectives: To describe a demonstration program that uses master's-level care managers (care advocates) to link Medicare managed care enrollees to home- and community-based services, testing whether referrals to noninsured services can reduce service usage and increase member satisfaction and retention.

Design: Using an algorithm designed to target frail, high-cost users of Medicare insured healthcare services, the program partners PacifiCare's Secure Horizons and four of its medical groups with two social service organizations.

Setting: Three care advocates located in two community-based social services agencies using telephone interviews to interact with targeted elders living in the community.

Participants: Three hundred ninety PacifiCare members aged 69 to 96 receiving care from four PacifiCare-contracted medical groups.

Intervention: The 12-month intervention provides telephone assessment, links to eight types of home- and community-based services, and monthly follow-up contacts.

Measurements: Sociodemographic characteristics of intervention participants, types of service referrals, and acceptance rates.

Results: Lessons learned included the importance of building a shared vision among partners, building on existing relationships between members and providers, and building trust without face-to-face interactions.

Conclusion: The program builds on current insured case management services and offers a practical bridge to community-based services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms
  • California
  • Community Health Services / organization & administration*
  • Community Health Services / statistics & numerical data
  • Female
  • Frail Elderly*
  • Health Services Accessibility / organization & administration*
  • Health Services Research
  • Home Care Services / organization & administration*
  • Home Care Services / statistics & numerical data
  • Humans
  • Male
  • Managed Care Programs / organization & administration*
  • Medicare / organization & administration
  • Patient Advocacy*
  • Patient Satisfaction
  • Pilot Projects
  • Program Evaluation
  • Referral and Consultation
  • Social Work