242709 Analyzing access barriers: Issues reported on CAHPS by patients with disabilities in a large urban Medicaid health plan, 2008-2010

Wednesday, November 2, 2011: 8:48 AM

S. Rae Starr, MPhil, MOrgBehav , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Earl Leonard III, MS , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Lisa Kodmur, MPH , Services for Seniors and People with Disabilities, L.A. Care Health Plan, Los Angeles, CA
Lynnette Hutcherson, RN , Utilization Management, L.A. Care Health Plan, Los Angeles, CA
Rus Billimoria, MBBS, MPH, CPHQ , Health Services, L.A. Care Health Plan, Los Angeles, CA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1. Identify methods to improve the actionability of CAHPS data for measuring disparities in access to care for Medicaid patients living with disabilities compared to the general Medicaid population. 2. Contrast issues reported by adult and pediatric patients living with disabilities. 3. Analyze patients' assessment of providers' competence in working with patients with disabilities. 4. Identify which access barriers are most frequently reported by patients with disabilities. 5. Discuss how Medicaid health plans that evolved to serve disproportionately pediatric populations, can adapt to accommodate adult patients with disabilities.

Keywords: Disability, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Experience: Six years as the Senior Biostatistician at L.A. Care Health Plan, managing the CAHPS survey for L.A. Care Health Plan from 2006 to 2011, including all facets of the survey to be discussed in the presentation. Designed survey of seniors and people living with disabilities (SPD) membership as a 2006 needs assessment to augment CAHPS in response to proposed policy in California to transition Medicaid SPD beneficiaries from fee-for-service to managed care coverage. Setting: L.A. Care Health Plan is a public entity serving Los Angeles County, California, and the largest public health insurer in the United States. L.A. Care's CAHPS survey represents voice for approximately 850,000 Medicaid and SCHIP members in an ethnically diverse, urban county in the southwest United States. The challenges addressed at L.A. Care likely reflect those of other urban Medicaid insurers, and of state agencies that sponsor the CAHPS survey directly. Education: Master of Philosophy in Policy Analysis from the RAND Graduate School of Policy Analysis (Santa Monica CA); Master of Organizational Behavior from Brigham Young University (Provo, UT); Bachelor of Political Science with Honors from Brigham Young University (Provo UT).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.