In July 2018, the Centers for Medicare and Medicaid Services (CMS) conducted targeted focus groups of Cal MediConnect (CMC) enrollees. The purpose of this qualitative research was to better understand the beneficiary experience in CMC related to:
- Program satisfaction,
- Service integration,
- Care coordination, and
- Overall well-being and quality of care
Researchers conducted 10 focus groups with beneficiaries from Los Angeles and San Mateo counties and interviewed 68 participants, including Spanish-language beneficiaries and consumers of Long-Term Services and Supports (LTSS).
The findings of the focus groups were published in a summary report in August 2018. Select findings are described below.
- Participants were satisfied with their medical and prescription coverage, access to additional benefits (dental, vision, hearing aids, transportation, health clubs) and good quality providers in convenient locations.
- Participants reported limited dental/vision coverage and difficulties with transportation services.
- Some beneficiaries also discussed dissatisfaction with being referred to providers who did not speak their native language and reported that it negatively impacted their experience and care.
- All 15 Spanish-language beneficiaries rated their satisfaction as “very satisfied.”
“A representative [from CMC plan] came out and she talked to me. I feel – it’s like I have a chance to do some things myself. It’s like a partnership…I watch my weight. I realize they’re there to remind me.” LA County Beneficiary
- All participants reported having a significant role in overseeing their own care, which is typically done in conjunction with their doctors. English-language participants had the most confidence in their ability to oversee their own care, while Spanish-language participants often use help due to general confusion around the health care system, lack of confidence in their ability to navigate it, and language barriers.
- Though many focus group participants could not identify their care coordinators, some reported that assistance from their care coordinators was extremely helpful when dealing with difficult insurance and medical system issues.
- For example, addressing inappropriate billing, long wait times for appointments, denial of drug coverage, and for identifying participating providers).
- Frequently, beneficiaries reported that care coordination enhanced their care, improved their awareness of available benefits/services, and contributed to their quality of life.
“My CMC plan, they give you referrals. Everybody is on the same network, so everyone knows what everyone is doing. That’s what I like about them. You can go to your medical doctor, your pain specialist, and whatever, and everybody is on the same line…reading the same notes.” LA County Beneficiary
Other Key Findings
- Enrollment: Many participants recalled the notification process and reported learning of CMC through letters, doctors and provider groups, phone calls, other professionals or agencies that help them with their care.
- Assessment of Needs, Care Goals, and Care Plan: Most participants recalled completing some type of assessment of their needs when they joined their CMC plan. Participants typically did not understand that this was a health risk assessment or a care plan.
- Long-Term Services and Supports (LTSS): Most LTSS participants described positive experiences when they transitioned from hospital/nursing care to their home. They shared that this was due to combined efforts from their plan or plan care coordinators, doctors, and the hospital.
- Quality/Wellbeing: Most CMC participants felt that CMC enrollment positively affected their lives.
Based on findings, the report also contains conclusions and detailed recommendations for CMC plans to better coordinate care and improve services like transportation, network adequacy, and specialized outreach to Spanish-speaking members. Lastly, the report concludes that Spanish-speakers can especially benefit from care coordination including receiving assistance with accessing services and more generally navigating the insurance and health care systems.
As the focus groups included a small number of participants, the findings do not necessarily reflect the experiences of the CMC enrollee population more broadly.