Helena Temkin-Greener, PhD¹, Alina Bajorska, MS¹, and Dana B. Mukamel, Ph D². (1) Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, 585 275 7813, helena_greener@urmc.rochester.edu, (2) Department of Medicine, Division of General Internal Medicine & Primary Care, University of California, Irvine, Health Policy Research, 100 Theory, Suite 110, Irvine, CA 92697

This is a first study to examine patterns and predictors of disenrollment in the Program of All-Inclusive Care for the Elderly (PACE). PACE is a managed care program providing comprehensive medical, long-term care, and support services to older, frail Medicare beneficiaries. The analytical file includes 14,657 enrollees of 30 PACE programs from 1989 through 2002. Time to disenrollment is modeled by Cox Proportional Hazard model with time-varying independent variables. Observations are censored due to death or the end of data. We observe significant variations in annual probability of disenrollment across programs, and between older (6.0%) and the more recently implemented programs (12.0%). Those more likely to disenroll are: persons not eligible for Medicaid (HR=1.93; p<0.0001); in poor health (HR=1.44; p<0.0001); with increasing number of hospital admissions (HR=1.52, p<0.0001) and nursing home days (e.g. HR=2.75; p<0.0001 for stays longer than 90 days) in the last 6 months. We also examine the predictors of disenrollment by reason given for leaving the program. Major reasons for disenrollment were moving out of the service area (28.1%), preference for own physician (10.6%), and unwillingness to comply with treatment plan (10.0%). Compared to Medicare HMOs, disenrollment from PACE is relatively low. However, selective disenrollment of persons in poorer health, raises questions about the ability of PACE to serve their target population. Voluntary disenrollment has social and fiscal implications for these programs and for the federal and state health policies that have come to rely on managed care to promote quality and contain costs.

Learning Objectives: At the end of the presentation participants will

• be familiar with patterns and predictors of disenrollment in PACE;
• be able to evaluate the impact of selective disenrollment on social and fiscal implications of programs serving the elderly.

Keywords: Aging, Health Care Managed Care

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: contractual agreement with the NPA