Analyzing access barriers: Issues reported on CAHPS by patients with disabilities in a large urban Medicaid health plan, 2008-2010

Mid-year in 2011, California will begin transitioning large numbers of Medicaid beneficiaries living with disabilities from fee-for-service to managed care coverage. Much of the focus in such transitions is properly on tangible and countable metrics of clinical activity: clinical encounters, diagnoses, co-morbidities, and treatments to maintain and manage conditions. Assessments from patients, themselves, are also important in guiding health plans' adaptation of services to meet the needs of patients new to managed care.

(1) Setting: This presentation will report how managed care patients with disabilities currently assess the quality of services they receive. The presentation will report the experience at one large urban Medicaid health plan in California, using CAHPS survey data (2008-2010) to compare the ratings given by patients with disabilities versus other patients.

(2) Adapting CAHPS to identify issues differentially impacting patients with disabilities: Although there is no substitute for surveying patients with disabilities using a questionnaire designed specifically to address disability-related issues arising in delivering health services. However, CAHPS is a survey done anyway by many health plans -- so it is wise to adapt CAHPS as source (albeit small-sample) for more data on problems and opportunities to improve services for patients with disabilities.

(3) Analyses: This presentation will report several findings for patients with disabilities: (a) differences between the quality of services versus general Medicaid patients; (b) contrast problems reported by adult versus pediatric patients; (c) report rates at which members suggest providers need disability-related training; (d) identify specific barriers reported by patients in accessing care.