California’s Duals Demonstration: Listening to Voices That Count the Most


Author: Bruce Chernof

Originally published: Tuesday, November 10, 2015

California is among a dozen states participating in the national demonstration to improve care for people with serious chronic illnesses and functional limitations who qualify for both Medicaid and Medicare. Historically, these programs have operated independently from one another, creating enormous challenges for those who need services and their circle of caregivers who work hard to piece together a plan of care. When this ad hoc care plan fails, the medical system’s backstop—emergency rooms and hospitals—is always open. These are places where no one wants to be and cost enormous sums of money, which could be spent more effectively by meeting people’s needs in the communities where they live.

The problem is that change is hard and the promise of something better is nothing more than that for many: a promise to be kept or broken. California’s duals integration pilot, while well-intentioned, had a challenging start due to resistance from some providers, caregivers, and those receiving services. While preserving the status quo has some allure, the traditional system of separate Medicare and Medicaid programs for those most in need is the least person-centered, most fragmented, and least efficient option. Many stakeholders have strongly held views, all with actual examples to support their position. Sadly, the collective voice of those using these programs is entirely absent from public discourse—today’s silent majority!

We thought that it was time to hear directly from a broad array of people using Medicare and Medicaid, particularly those enrolled in the state’s demonstration, Cal MediConnect. It is their experiences that count the most, their needs that have to be met, and their voices that must define the path forward.

With that in mind, we commissioned the Field Research Corporation to poll more than 2,500 dually eligible individuals in California, including those enrolled and those opting out in five demonstration counties, as well as people in non-demonstration counties. Field looked at people’s satisfaction, early experiences, and confidence in getting their needs met.

What did the Field survey find? People in Cal MediConnect reported positive experiences, with majorities stating satisfaction or confidence, in the following areas:

  • Getting their questions answered about health needs,
  • How to manage their health conditions,
  • Choice of doctors and hospitals,
  • The amount of time that doctors and staff spent with them,
  • The way in which health care providers work together, and
  • The information that health plans provide to explain their benefits.

While the survey highlights these positive experiences, it also shows specific areas where state officials, health plans, physician groups, and other providers need to take meaningful action to improve the program’s functioning. For example, those enrolled in the program were less likely than their fee-for-services counterparts to be “very confident” about how to manage their health conditions or “very satisfied” with their choice of and coordination among providers.

We call on the state and its contracted providers to take these results seriously and respond to the voices from this population calling for continued improvements. Several key issues remain, such as the following:

  • The need for continued communications to eligible individuals and their caregivers on how to get the most out of an integrated care model,
  • How to improve the depth of care coordination, and
  • How to build their confidence in getting daily needs met in order to protect their dignity.

There is a continued need to educate providers and respond to their valid concerns while clarifying and, if needed, pushing back on misperceptions. These results also show how critical it is for health plans to deliver a real plan of care with a full range of traditional medical and community-based services.

We are committed to hearing the voices of Californians who have Medicare and Medicaid coverage so that their needs are fully addressed. Field will release another round of polling later this year, with more to come in 2016. We thank those who responded to the first survey, taking time to speak up and out.

The promise of better, more integrated, and person-centered care in California must be kept. Even in the early goings of such a substantial service restructuring, this first round of polling shows a good start.

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