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Title: Medicaid managed care "switchers" : characteristics and reasons for switching
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Title: Medicaid managed care "switchers" : characteristics and reasons for switching
Physical Description: Book
Language: English
Creator: Hall, Allyson
Publisher: Florida Center for Medicaid & the Uninsured, College of Public Health and Health Professions
Place of Publication: Gainesville, Fla.
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Volume ID: VID00001
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Full Text




Medicaid Managed Care "Switchers"
Characteristics and Reasons for Switching


Allyson Hall, PhD
Heather Steingraber, MAC (ABT)
Amanda Bhikhari, MHA


IMrAIUm
Florida Center for Medicaid and the Uninsured
Shaping Healthcare Policy
The Florida Center for Medicaid and the Uninsured
College of Public Health and Health Professions
University of Florida
352/273-5059


FLORCDA AGENCY FOR HEALTH CARE ADMINISTRATION
Sponsored by
The Agency for Health Care Administration
2727 Mahan Drive
Tallahassee. Florida 32308


September, 2004









Table of Contents































Figures


Executive Summary ..................................... ............3
Background and Introduction ........................................5
Medicaid Managed Care Organizations...................5
C hanging M CO s....................................... .......... ... 5
Methodology and Sample Selection............................. 6
Outcome Rates ........................................... .............. 7
Demographics .................................................... ....... 7
Gender ............................ .................................... 7
A ge .................................. .................................... 7
Race ........................................................ ................8
Ethnicity ...................................................... ............. 8
Hea lth Status ............................................. ......... .... 9
Plan C choice .................................................. ............. ..9
Hea lth Utilization .................................................. 9
Reasons for Switching ...................................... ... 10
HM O to M ediPass .................................... .............. 1
HM O to HM O .................................................. ...... 12
MediPass to HMO ................................................ 13
Negative Experiences with Health Plans.................13
Comparison of Old and New
Managed Care Arrangements............................. ..14
Sources of Information about Managed Care............ 15
Medicaid Stigma ................................................. 16
Comparison of 2003 vs. 2004..........................................17
Hea lth Sta tus .............................................................. 17
Reasons for Sw itching .................................. ......... 1 7
Summary and Recommendations....................... ..18


Figure 1. Mean Age of Switchers...............................8
Figure 2. Race and Ethnicity of Switchers ................8
Figure 3. Self-Reported Health Status of Switchers .....9
Figure 4. Health Plan Choice..........................................9
Figure 5. Health Utilization .......................................... 10
Figure 6. Reasons for Switching, Overall...................11
Figure 7. Reasons for Switching, HMO to MediPass..12
Figure 8. Reasons for Switching, HMO to HMO .........12
Figure 9. Reasons for Switching, MediPass to HMO..13
Figure 10. Source of Negative Experience with
Hea lth Pla n ................................... ........... 14
Figure 11. Perceived Differences Between
Old and New Plans ..................................... 15
Figure 12. Source of Information about New Plan......16









Appendices ................................................................................20

Survey FCMU "Switchers" Survey Instrument



Tables Table 1: Demographic Characteristics of Plan Switchers
Overall and by Switch Group

Table 2: Reasons for Switching Managed Care
Arrangements: Overall and by Switch Group

Table 3: Perceived Differences between Old Plan and
New Plan: Overall and by Switch Group

Table 4: Sources of Information About New Plan,
Medicaid Bias, and Health Plan Choice









Executive Summary


The Medicaid "Switcher" survey was conducted by the
Florida Center for Medicaid & the Uninsured (FCMU)
under contract with the Agency for Health Care
Administration (AHCA). This survey was designed to
provide outcome rates and assess the reasons why
Medicaid enrollees voluntarily change or "switch" from
one managed care arrangement to another during open
enrollment. Demographic information and overall
satisfaction with care measures was also collected so that
these dimensions can be compared with the overall
Medicaid population.

AHCA has two main types of managed care
arrangements to oversee the health care of Medicaid
enrollees: Health Maintenance Organizations (HMOs) and
the Medicaid Provider Access System (MediPass). As of
the fall of 2003, which is the time period when the survey
sample was drawn, Medicaid HMOs were available in 34
of the 67 Florida counties, and 23 counties offered more
than one HMO to their enrollees. All counties offer the
MediPass program.

In the winter of 2003, AHCA identified 4,409 adult non-
elderly Medicaid enrollees, who had switched managed
care arrangements in the months of October or
November, 2003. This group of enrollees was chosen as a
potential subject pool to participate in telephone surveys
regarding the reasons for their MCO switch. After
removing duplicate records and taking multiple measures
to find valid contact information for respondents, only
82% (n=3,632) of the sample remained valid; that is each
record had a 10-digit telephone number and was not a
duplicate record.

Survey data was analyzed across three switch groups
(HMO to MediPass, MediPass to HMO, and HMO to HMO).
Among the demographic variables analyzed, significant
differences were found between the 3 switch groups in
the proportion of Black and White races. The HMO to
HMO group was made up of a larger percentage of
Blacks and a smaller percentage of Whites than the other
groups.

In 2004, a greater proportion of respondents said they
were either in poor or fair health (40%) as compared to
only 27% in 2003. This indicates a worse reported health
status overall in 2004 as compared to the previous year.
The health status between switch groups for both years
was relatively similar and not statistically significant.








Survey respondents were more likely to report that they
chose (rather than were assigned) to their new plan
compared to their old plan. The percent choosing their
old managed care arrangement varied significantly
across the 3 switch groups. Those who switched from an
HMO to MediPass were less likely than the other groups to
report choosing their old plan.

Respondents were asked to compare their old and new
MCOs on several attributes such as choice of providers,
ease of obtaining a medical appointment, and suitability
for people who take multiple prescriptions. On the overall
ratings of the two managed care arrangements,
respondents rated their new plan higher than their old
plans. However, no statistically significant differences
were found.

In conclusion, approximately 4,400 Medicaid beneficiaries
switched managed care arrangements during a period
of two months. In a one-year period, approximately
26,500 beneficiaries can be expected to change their
managed care arrangements. The switching of
managed care arrangements can create significant
administrative burden for Medicaid administration and
can have implications for continuity of care for patients.
Increasing provider selection and availability, providing
choice to beneficiaries instead of assigning them and
reviewing the open enrollment periods may help to
address these issues.

This study provides an initial look into the experiences of
Medicaid beneficiaries who switch health plans. Further
research, especially longitudinal studies, are needed.
Additional research questions include understanding:
the extent to which switchers vary by health plan
and by geographic region
how provider availability within regions across the
state influences switching
the impact of an HMO market exit on future
choice of managed care arrangement
how the actual process of switching may deter or
encourage plan switching
the extent to which switchers are more satisfied 1
or 2 years later
the role health plan marketing plays in
encouraging beneficiaries to switch managed
care arrangements.








Background and Introduction












Medicaid Managed Care
Organizations


Changing MCOs


SAnother type of managed care arrangement, the Provider S
on a very limited basis. As of April, 2004, only residents of Brow


The purpose of this report is to provide outcome rates for
the Medicaid "Switcher" survey conducted by the Florida
Center for Medicaid & the Uninsured (FCMU) under
contract with the Agency for Health Care Administration.
This survey was designed to assess the reasons why
Medicaid enrollees voluntarily change or "switch" from
one managed care arrangement to another during open
enrollment. In addition, the survey gathered
demographic information and overall satisfaction with
care measures on "Switchers," so that these dimensions
can be compared with the overall Medicaid population.

The Agency for Health Care Administration (AHCA) has
two types' of managed care arrangements to oversee
the health care of Medicaid enrollees: Health
Maintenance Organizations (HMOs) and the Medicaid
Provider Access System (MediPass). The HMOs and the
MediPass program offer benefits packages that are
substantially similar, though the HMOs may offer
additional special services such as transportation to
medical appointments, and over-the-counter drug
reimbursement. The two types of managed care
arrangements differ in how they manage the care of their
enrollees and in how they manage the providers in their
network. Further information on the differences can be
found in the Florida Medicaid Summary of Services. As of
the fall of 2003, which is the time period when the survey
sample was drawn, Medicaid HMOs were available in 34
of the 67 Florida counties, and 23 counties offered more
than one HMO to their enrollees. All counties offer the
MediPass program.

Upon enrollment, those who reside in counties without
HMOs are automatically enrolled in MediPass, while those
who reside in counties with HMOs must choose from
MediPass and the HMO(s) offered in their county. If an
enrollee fails to indicate his or her choice to Medicaid
within 30 days of the date Medicaid eligibility began, he
or she is assigned to one of the MCOs by AHCA.

Each year, an open enrollment period is offered, in which
recipients have 90 days to try a new plan. After this initial
90-day period, the recipient is "locked-in" to the plan and
must remain in this plan for the next 9 months, barring loss
of Medicaid eligibility or a "good cause" to change
plans. To make the switch, a recipient must telephone
the Medicaid Options toll-free help line during operating
hours (Monday through Friday, 8 am 7 pm) to indicate
the desired MCO change.


service Network, or PSN, also exists in Florida Medicaid. However, it is offered
ard and Miami-Dade counties could enroll in the PSN, and PSN enrollment 5


totaled 17,949 members, or approximately 1.25% of Medicaid managed care enrollment. PSNs are not considered in this report because
they are offered in such a limited area, and their enrollment represents such a small portion of Medicaid enrollment overall.







Methodology and Sample In the winter of 2003, the Agency for Health Care
Selection Administration identified 4,409 adult non-elderly
Medicaid enrollees, who had voluntarily switched
managed care arrangements in the months of October
or November, 2003. This group of enrollees was chosen
as a potential subject pool to participate in telephone
surveys regarding the reasons for their MCO switch.

The Survey Research Center at the University of Florida's
Bureau of Economic and Business Research was
contracted to carry out the survey process in the winter
of 2003 and spring of 2004. The quality of the contact
information for enrollees was poor, with nearly 12%
(N=534 out of 4,409) of the sample having no telephone
number on file with AHCA. Many measures were taken
to find valid contact information for respondents.
Measures included contacting commercial
organizations that provide contact information for
telephone surveyors and marketers and matching the
records with current Driver's License records obtained
from the Florida Department of Highway Safety and
Motor Vehicles. Following these steps, and the removal
of duplicate records, only 82% (N=3,632) of the sample
remained valid; that is, each record had a 10-digit
phone number and was not a duplicate record.
Subjects were contacted up to 42 times by phone in an
attempt to secure cooperation or obtain updated
contact information. Despite these attempts, a large
number of respondents proved to be unreachable.
Perhaps this should not come as a surprise, considering
that a common reason for switching MCOs may be that
enrollees have moved, and thus, have easier access to
providers on a different MCO.

An important aspect in determining whether survey
results are truly representative of the population in
question is to determine whether "non-response effects"
exist. Non-response effects occur when non-
respondents from the original sample differ from those
who did respond in significant ways that might affect
results of the study. One important step in determining
whether non-response effects exist is to calculate
outcome rates.

The American Association for Public Opinion Research
(AAPOR) recognizes the use of a number of different
types of outcome rates, and a number of different
methods for calculating each of those types'. One type
of outcome rate is the Response Rate (RR), which takes
into account the number of interviews in proportion to
the number of eligible respondents.


'The American Association for Public Opinion Research. 2000. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for
Surveys. Ann Arbor, Michigan: AAPOR




























Outcome Rates







Demographics





Gender



Age


Numerous methods exist to calculate Response Rates,
with major differences being in the way in which the
number of eligibles is determined and the way partial
interviews are allocated. Another type of outcome rate
is the Cooperation Rate (COOP), which takes into
consideration the number of interviews in proportion to
all eligibles ever contacted. Cooperation Rates
exclude from calculation those respondents who could
not be located. Like Response Rates, there are
numerous ways to calculate Cooperation Rates, with
the major differences being in the way that the number
of eligibles is determined and the way partial interviews
are allocated. Researchers consider various criteria in
determining which outcome method to use, with the
quality of the sample being a major criterion in their
decision.

A total of 353 surveys were completed, yielding a
confidence interval of 5% for all results. The response
rates for the surveys ranged from 58% to 63%,
depending on the RR calculation method. The
cooperation rates for the survey was also good, with
rates ranging from 73% for COOP1 to 80% for COOP4.
The refusal rates ranged from 14% to 16%.

Demographic information such as gender, age, race,
ethnicity, and health status was gathered for all survey
respondents. Generally, respondents do not show a
significant difference in demographic dimensions.
Results are given below.

The majority of switchers are female (84 percent) rather
than male (17 percent) reflecting the general
distribution of the Medicaid population.

The three switch groups were found not to be
statistically significantly different from each other;
however, with the MediPass to HMO group being slightly
younger than either of the other two groups. This
group's mean age was 38.66 14.56 years, compared
with 42.7715.77 years for the HMO to MediPass group
and 42.63 18.10 years for the HMO to HMO group
(Figure 1).










Figure 1 : Mean Age of Switchers
60
50- 42 43 39 43
40
30
20

Ol I I I
10

I- 0 o
Jo o "O


EAge in Years

Just over half of the switchers (54.11%) indicated that
their race was White, while 33% were Black, 3% were
Native American, and 2% were Asian. A further 16.15%
of respondents described their race as something
"Other" than any of these categories. There were
significant differences between the 3 switch groups in
the proportion of Black and White races. The HMO to
HMO group was made up of a larger percentage of
Blacks (p<0.05) and a smaller percentage of Whites
than the other groups. Forty-one percent of
respondents in this group described themselves as being
Black, compared with 23.9% of the HMO to MediPass
group and 37.66% of the MediPass to HMO group.
(Figure 2).


Figure 2 : Race of Switchers
100%

80%
61%
60% 54% 55%
8% 41%
40% 33%
24%
16 24%% 18% 18%
20%.

0%
Total HMOto MediPassto HMOtoHMO
MediPass HMO
IWhite U Black DAsianlNative American MOther

Ethnicity Thirty-two percent of Medicaid plan switchers surveyed
reported that they were Hispanic, while 68% reported
that they were not Hispanic. The three switch groups
did not differ significantly in terms of Hispanic makeup.


V








Health Status


Almost 40 percent of all switchers reported that they
were in fair or poor health. However, differences in
health status across the three groups were found not to
be statistically significant. (Figure 3).
Figure 3 : Self Reported Health Status of Switchers


100%

80%

60%

40%

20%

0%


m7
22%9

30%

18%


24%1

27%

18%


17%

24%

22%


22%


36%

16%
611iNIii


- i L I I -. ~


Total


Plan Choice


HMOto MediPass HMOtoHMO
MediPass to HMO


1 Excellent O Very Good 0 Good U Fair Poor

Respondents were more likely to report that they chose
(rather than were assigned) to their new plan
compared to their old plan. Overall, about 47 percent
of respondents reported that the chose their old plan
(data not shown). In comparison 89 percent reported
that they chose their new plan. The percent choosing
their old managed care arrangement varied
significantly across switcher types (p=.001). Those who
switched from an HMO to MediPass were less likely than
the other groups to report choosing their old plan
(Figure 4)


Figure 4: Health Plan Choice


HMOto MediPassto HMOtoHMO
MediPass HMO


IChose New Plan EWas Assigned New Plan


Health Utilization


Overall, about 82 percent of respondents reported
"yes", they used the new plan for medical care or
prescriptions. This is proof that the medical care and
prescriptions provided are being used by a majority of
patients, and supports the need for effective health


100%

80%

60%

40%

20%

0%


Total







care to reach out to the minority of respondents who
are not using the services available to them. However,
there are no significant differences in utilization across
the three switch groups. (Figure 5)
Figure 5: Health Utilization
100%]

80%

60%

40%-

20% 18% 15% 18% 21%

0% I I
Total HMO to MediPass to HMO to HMO
MediPass HMO
SYes i No


Reasons for Switching Respondents were asked about the reasons why they
switched MCOs. Subjects were given eight possible
reasons and asked whether they agreed or disagreed
with each reason. Results are given below.

Respondents were most likely to strongly agree or agree
that they switched health plans because of better
benefits available to them in the health plan (79.18%) and
because of a better selection of providers (PCPs)
(77.68%). Seventy percent strongly agreed or agreed that
they switched because a specific provider was not on
their old plan. When asked what type of provider that
was, 47% indicated that it was a primary care provider,
while 32% indicated it was a specialist, 10% said it was a
dentist and 12% indicated some other type of provider,
such as a nurse. Sixty-nine percent of respondents
agreed that they switched plans because the new plan
offered providers and facilities that were more
conveniently located than the ones on their old plan. The
next most commonly cited reason for switching plans was
that the enrollee believed that the new plan would result
in fewer out-of-pocket expenses than the old plan. This
reason was cited by nearly half (48.4%) of respondents.
Other reasons given included that the enrollee wanted to
be in the same MCO as another family member (26.5%)
and that they or a friend had a bad experience with the
old plan (28.5%). (Figure 6)








100%-
80%
60%
40%-
20%-
0%.


HMO to MediPass


There were some differences between the three switch
groups in terms of reasons for changing MCOs. For those
going from an HMO to MediPass, most agree that they
switched because they felt they had a better selection of
providers under the new arrangement. In contrast those
moving from MediPass to HMO were more likely to agree
that they received better benefits in the new plan. And
those going from one HMO to another HMO were about
as equally as likely to agree that better benefits and a
better selection of providers were available in the new
plan.

Among the HMO to MediPass group, 81% indicated that
they switched to MediPass because they felt it had a
better overall selection of providers than the HMO(s). The
next most frequently cited reason for switching among
this group was that there were better benefits and
features in MediPass as compared to HMO. This reason
was cited by 79% of respondents in this group. Seventy
percent of respondents indicated that they switched
because their old plan was too restrictive regarding
provider choice and visits, and 74% indicated that they
switched because the facilities and providers in the new
plan were more conveniently located. Seventy-seven
percent of HMO to MediPass switchers indicated that
they switched because a specific provider was not on the
HMO plan. Fifty-two percent indicated they thought they
would pay less out-of-pocket in MediPass than in their
HMO. Thirty-four percent of respondents switched
because they had a bad experience with their HMO.
Twenty-seven percent switched because another family
member was on MediPass (Figure 7).


Figure 6 : Reasons for Switching,
Overall







=F 0 -
,- ,, =. .o 8 8CE
; Z U, 2 EZ i
C m- "S z m g ,,

*StronglyAgree *Agree









100%
80%
60%
40%
20%
0%


HMO to HMO


Figure 7: Reasons for Switching,
HMO to MediPass


ii..


CL a o-z a.le o E i



Respondents who switched from one HMO to another most




respondents in this group. The next most commonly cited
reason for switching, given by 75% of respondents, was that





the new plan had better benefits or features than the old
plan. Sixty-eight percent indicated that they felt the
providers and facilities in the new plan were more
FStrongly Agree *Agree
Respondents who switched from one HMO to another most




conveniently located than those in the old plan. Sixty-four
percent switched because a specific provider was not on
than their old plan, and 60%This reported that their old plan was too
respondent of this group thought that their new plan would
cover more of their out-of-pocket expenses, andents, was that
the new plan had better benefits or features than the old
plan. Sixty-eight percent indicated that they felt the



providers and facilities ito be on the same plan whereas a family member. The
reason cited least frequently located that those in the old plan. Sixty-four
percent switched because a specific provider was not on



their old plan, and 60% reported thatience with their old plan. This was cited by 26% of
restripondents in the HMO tprovider choice and visits. Thirty-ninee 8)
percent of this group thought that their new plan would
cover more of their out-of-pocket expenses, and 29%
switched to be on the same plan as a family member. The
reason cited least frequently was that they had a bad
experience with their old plan. This was cited by 26% of
respondents in the HMO to HMO group. (Figure 8)
Figure 8, Reasons for Switching,
100% HMO to HMO
80%
60%
40%
20%
0%


o o 0o
cii
00 ~ 0
l- I
S -"
0 0
Ca 3
LL


- O 0

S g 0ge IO
0L 0 CL



*Strongly Agree *Agree








MediPass to HMO


Negative Experiences with
Health Plans


Among respondents who switched from MediPass to an
HMO, the most common cited reason for making this
switch (cited by 83% of respondents) was that the HMO
had better benefits or features than MediPass. Next most
common (72%) was that they felt the HMO had a better
overall selection of providers. There were equal
respondents (61%) who switched due to either a more
convenient location and facility or because a specific
provider was not on the MediPass plan. Fifty-seven
percent of the respondents in this group indicated that
they felt MediPass was too restrictive regarding provider
choice and visits. Fifty-four percent said that they felt
enrolling in the HMO would result in fewer out-of-pocket
expenses than in MediPass. Twenty-two percent of
respondents switched because another family member
was on the HMO, and 20% reported switching due to a
bad experience with MediPass (Figure 9).


100% -
80%-
60%
40%-
20%
0%-


Figure 9: Reasons for Switching,
Medipass to HMO






S~'O O-z 0 00 ,,
.t B Z Ifgree W
S = cc c cC -0 S E

g S~i S o U )
m m QrMAgre g
*Strongly Agree *Agree


Those respondents who reported having switched plans
due to (at least in part) a bad experience with their old
plan (n=97) were asked for more detail about that
negative experience. Fifty-six percent of these
respondents overall indicated that the experience was
with a doctor or doctor's staff, while 67% said the bad
experience had to do with getting a referral. Negative
experiences with the MCO's customer service or
complaint department were reported by 42% of this
group. Other sources of negative experiences included
health providers other than doctors, dentists, or
pharmacists (45%), billing or claims issues (46%),
pharmacists or other pharmacy staff (28%), and dentists
(18%). Twenty-eight percent of this group reported
another source of negative experiences. (Figure 10).







Comparison of Old and New Figure 10 : Source of Negative Experience
Managed Care Arrangements 100% with Health Plan

80%- 67%
56%
45% 46% 42%
40% -28% 28%
18%
20%
0%|111
o o I
0 S a O
*Percent of "yes" responses
Respondents were asked to compare their old and new
MCOs on several attributes, including the following:

Choice of Primary Care Physicians,
Choice of Specialist Physicians,
Choice of Dentists,
Mental/emotional health benefits,
Suitability for people with special health care
needs,
Suitability for people who take multiple prescription
medicines,
Suitability for people who need to minimize out-of-
pocket expenses,
Suitability for non-English speakers,
Courteousness overall, and
Ease of obtaining a medical appointment.

Respondents were also asked to provide an overall rating
on a scale of 1 to 10 of both their old and new health
plans. Results are given below.

On the overall ratings of the two managed care
arrangements, respondents rated their new plan (8.21)
higher than their old plans (6.13).

Similarly, for all attributes, respondents rated their new
plan as being better than their old plan. Of note, is the
fact that along a number of dimensions, a number of
respondents reported that there was no difference
between their old and new managed care plans. In
addition, there was no statistically significant difference
across the three switch groups in reported differences
between old and new plans (Figure 11).









Sources of Information about Figure 11: Perceived Differences Between Old
Managed Care 100% and New Plans

80%
60% 55 58 50 47 55 52 57 57 55
60% 5 50 47 52
44 4744
40% 36 34 38 35 6 43 6



0%
0%
0 W T. .2 0 W


were also able o provide a response about the




source of information. Results are discussed below.






The mos0 common source of information about new
SOld Plan thNew Plan No Difference


Respondents were asked how they heard about their new
MCO. Subjects were offered five possible sources of
information and allowed to indicate whether they had
received information from each of these sources. They
were also able to provide a free text response about the
source of information. Results are discussed below.

The most common source of information about new
MCOs was received through the mail. Forty-eight percent
of respondents overall indicated that they had received
information from the new plan through the mail, though it
is not known whether the mail was sent in response to a
request for information from the enrollee, or was
unsolicited. Those moving from MediPass to HMO were
more likely to report getting new information from the
mail relative to the other two groups. Furthermore,
respondents were not asked who sent the information to
them, so it is not known whether the MCO or plan sent the
information, or whether the Agency sent it.

Another common source of information about MCOs,
given by 27% of respondents, were State agencies, such
as AHCA or the Department of Children and Families
(DCF). It is not known whether this information was
obtained in person at an Agency office, over the phone,
or through the Medicaid Options hotline.

Many respondents received information via word of
mouth from friends and family (29%), and through
advertisements about the plan (23%). Twenty-one
percent of respondents indicated they received a







telephone call from the new plan, and 32% indicated
that a doctor or other health provider gave them
information about the plan. Other sources of information
reported included health fairs, in-person visits from plan
representatives, and information distributed at the
enrollee's workplace. (Figure 12)

Figure 12: Source of Information about New
100% Plan
80%
60%- 48%
40%- 21% 23% 27% 29% 32%
20%
0%
a21 E



I Percent of "yes" responses


Medicaid Stigma Because Medicaid is a State/Federal program, it may be
perceived by many to be "Welfare" or an entitlement.
Many Medicaid enrollees have reported that they
experience prejudice from health providers and others. In
order to gauge the extent to which this occurs among
Florida Medicaid population, all respondents in this survey
were asked whether they had ever felt that they were
treated differently because they were enrolled in
Medicaid compared with enrollees in other types of
health insurance. Those who had experienced bias were
also asked who showed bias, and to describe the event in
their own words. Results are discussed below.

Approximately 26 percent of respondents indicated that
they felt they been treated differently due to their
Medicaid enrollment on at least one occasion. When
asked who had shown this bias, half of these respondents
said that a doctor or doctor's staff had shown bias, while
5% indicated that it was a dentist or dentist's staff, and 7%
said it was someone at a pharmacy. Another 9% of
respondents indicated that it was another type of health
provider or that it was multiple types of providers who
showed bias. Thirty percent indicated that the bias was
shown by a non-health provider. There were no
differences between the three switch groups on these
measures.

















Comparison of 2003 vs. 2004






Health Status






Reasons for Switching


As a whole, subjects reported experiencing three types of
bias associated with Medicaid:

1) Longer waiting periods for medical
appointments.
2) Longer wait times in doctor's offices.
3) Perfunctory or cursory treatment and
examinations.

When reviewing survey results from the previous year, and
comparing them to the current year, there were a few
disparities among the different categories as well as
between the 3 different groups. The overall categories
are presented below.

In 2004, a greater proportion of respondents said they
were either in poor or fair health (40%) as compared to
only 27% in 2003. This indicates a worse reported health
status overall in 2004 as compared to the previous year.
The health status between switch groups for both years
were relatively similar and not statistically significant.

While there are many similarities between the two years
regarding reasons for switching arrangements, there were
several differences as well. For example, in 2004, there
was a higher number of respondents (72%) who either
strongly agreed or agreed that their new plan would
have a better selection of providers than compared to
the previous year (56%). Also, there was a decrease in
the HMO to HMO group in 2004 (39%), regarding their
thoughts that switching would result in lower out of pocket
costs as compared to 2003 (51%). This is noteworthy
because for the other two groups, MediPass to HMO and
HMO to MediPass there was an increase regarding
thoughts that the new plan would result in lower out of
pocket costs.







Summary and As indicated, approximately 4,400 Medicaid beneficiaries
Recommendations switched managed care arrangements during a period
of two months. In a one- year period, approximately
26,500 beneficiaries can be expected to change their
managed care arrangements. The switching of
managed care arrangements can create a significant
administrative burden for Medicaid administration and
can have implications for continuity of care for patients.

A clue to understanding the motivation of switchers is the
fact that the majority of respondents indicated that they
were assigned to rather than chose their original health
plan. The original assignment, therefore, may not be
particularly suited to a patient's needs. One need that
appears to prompt switching is provider availability.
Specifically, the majority of respondents agreed that they
switched because the new arrangement had a better
selection of providers, provider location was more
convenient or that a specific provider was not available
under the old plan. The degree to which respondents
strongly agreed with statements about provider
availability varies across the switcher groups, providing
some indication that some forms of managed care may
have better provider accessibility than others. Another
point to be recognized is that switching seems to be
prompted by assignment to a specific plan. For example,
as the survey shows, HMO to MediPass patients are more
likely to chose their own plan, which indicates a higher
level of dissatisfaction with Medicaid automatic
assignment choices. Respondents also indicated that
restrictions regarding provider choice and that there may
be better benefits under a new plan are also significant
reasons for changing. Interestingly, few respondents
indicated they switched because of a bad experience
with a plan.

Another stimulus for switching could be from health plan
marketing efforts. Forty-eight percent of respondents
indicated that mail from the health plan was a major
source of information about that plan. Twenty-three
percent of the switchers found out about the plan
through an advertisement.







Switchers tended to provide a higher rating for the new
managed care arrangement. However, it also important
to note that many respondents found no difference
between the two arrangements. Very few people found
the new plan to be worse than the old plan. Those
respondents that did change were motivated by their
own personal choice. This may indicate some bias in the
higher rating of new arrangements due to the fact that
personal choice was the driving factor.

This study provides an initial look into the experiences of
Medicaid beneficiaries who switch health plans. Further
research, especially if it is longitudinal in nature is needed.
Additional research questions include understanding:
the extent to which switchers vary by health plan
and by geographic region
how provider availability within regions across the
state influences switching
the impact of an HMO market exit on future
choice of managed care arrangement
how the actual process of switching may deter or
encourage plan switching
the extent to which switchers are more satisfied 1
or 2 years later
the role health plan marketing plays in
encouraging beneficiaries to switch managed
care arrangements.








APPENDICIES








FCMU Switcher Survey


Survey conducted in Fall 2003 with Adult Medicaid Enrollees who voluntarily switched from the MediPass
program to an HMO or vice versa, or switched from one HMO to another.

Interviewer notes/administration instructions in italics.
Field names in ALL CAPS to the left of each item.
For all items: -8 = Don't Know, -9 = Refused. Unless noted, the skip sequences for these options are the same as
for "No" or "Disagree."

OLDPLAN = The program that the respondent disenrolled from: Either an HMO name or "MediPass"
NEWPLAN= The program that the respondent switched to: Either an HMO name or "MediPass "

Programmer note: please use the field names and response category values indicated on this hard
copy!


HELLO Hello. My name is and I am calling from the Survey Research Center at the
University of Florida. I'm calling on behalf of the Florida Medicaid program.

May I speak to (target name)?

If yes, reintroduce yourself if necessary

Ifno, Is there another time I could call back to talk to him/her? Schedule a call
back if necessary and thank the respondent for his/her time.

INTRO The Medicaid program has asked the University of Florida to conduct a survey of people who are
enrolled in their programs. Specifically, Medicaid would like to know about people's experiences with
their programs.

ADVISE I need to tell you a couple of things before we get started. You do not have to answer any
question you don't want to. You don't have to participate in the survey at all. No one not even
Medicaid will know if you participated or not, and your name will not be reported to anyone else. All of
the participant responses will be totaled together when presented to Florida Medicaid. In addition, data
from this survey may be published publicly, but again, it will be presented in totals, not in individual
responses. If you don't have any questions, would you like to participate in this survey? (if no, then
"thank you very much for your time" if yes, then "let's get started with the interview")

CONFIRM My records show that you used to be covered by (insert OLDPLAN), but you are now
covered by (insert NEWPLAN). Is this correct?

1. Yes Go to NEWOPEN
2. No

MCAID It is possible that my records are wrong. Are you currently enrolled in Medicaid?

1. Yes
2. No Apologize for the inconvenience and thank the respondent for his/her time.








COVERAGE What Medicaid program or health plan are you currently covered by? If respondent
needs help recalling the name, read the list below. Oiliei n i\e, just code their response.


1. MediPass

2. Amerigroup
3.
4.
5. Buena Vista
6.
7.
8. HealthEase
9. Healthy Palm Beaches
10.
11. Healthy Palm Beaches
12. Humana
13. JMH Health Plan
14. Neighborhood Health Partnership
15.
16. Preferred Medical Plan
17.
18. Staywell
19. United Healthcare Plans
20. United Eldercare
21. Vista Healthplan of S. Florida
22.
23. Other (Specify

Apologizefor the inconvenience and thank the respondentfor his/her time.


NEWOPEN The first I thing I want to ask is about NEWPLAN. Can you tell me, in your own words, how
you first found out that you could choose NEWPLAN as your Medicaid health plan?
Interviewer: Record response verbatim

HOWHEAR Ok. Now I'm going to ask you a series of questions about specific ways you might have
found out that NEWPLAN is a Medicaid health plan in your county.

NEWCALL Did someone from NEWPLAN call you?

1....................... Y es
2................. .... N o

NEWMAIL Did you get something in the mail from NEWPLAN?

1. Yes
2. No








NEWFRIEN Did a friend or family member tell you about NEWPLAN?

1. Yes
2. No

NEWPROVI Did a doctor or other health provider tell you about NEWPLAN?

1. Yes
2. No

NEWSTATE Did someone from Medicaid or DCF tell you about NEWPLAN?


1. Yes
2. No

NEWPLAN Did you see an ad for NEWPLAN?

1. Yes
2. No


NEWOTHE Is there some other way you heard about NEWPLAN?

1. Yes (go to NEWOPEN)
2. No (go to OLDCHOIC)


SWWHY I am interested in the reason or reasons why you switched from OLDPLAN to
NEWPLAN. Can you explain to me in your own words why you switched?
(Interviewer: Record response verbatim)

DEFINITI Keep in mind throughout this survey that when I use the word "provider," I am talking
about people like doctors, dentists, nurse practitioners, and therapists. When I use the
word "staff" I am talking about people who work for or work with the provider. So, for
example, that might be a nurse, a receptionist, or a laboratory technician. Does that make
sense?

SWREASON Ok. Now I'm going to read you a list of reasons that other people have given for
switching plans. For each statement I read to you, I'd like you to tell me whether
strongly agree, agree, disagree, or strongly disagree with that statement.

SWPROV I switched plans because a specific provider that I wanted to see was not on OLDPLAN
but was on NEWPLAN?
1. Strongly Agree (go to SWPROTYP)
2. Agree (go to SWPROTYP)
3. Disagree (go to SWDOCCHO)
4. Strongly Disagree (go to SWDOCCHO)









SWPROTYP What kind of provider was it that you wanted to see? Was it a...


1. Primary care provider,
(If needed, "A primary care physician is a doctor who...get
definition from CAHPS)
2. A specialist, (get definition from CAHPS)
3. A dentist
4. Other

SWDOCCHO I switched plans because NEWPLAN had a better overall selection of providers than OLDPLAN?

1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree

SWLIMIT I switched plans because OLDPLAN had too many limitations on what providers I could
see and how often I could see them?

1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree

SWBENEFI I switched plans because there were certain benefits that were not included in OLDPLAN
but were included in NEWPLAN

1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree

SWMONEY I switched plans because I felt I would pay less for my medical care on NEWPLAN as
compared to OLDPLAN?

1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree

SWSAME I switched plans because someone else in my family was on NEWPLAN and I wanted to be on
the same plan as they were?

1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree








SWTRANS


I switched plans because the doctors offices and other health care facilities on
NEWPLAN are more conveniently located or easier for me to get to than the ones on
OLDPLAN?


1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree

SWBAD I switched plans because I had a bad experience or someone I know had a bad experience
with OLDPLAN?

1. Strongly Agree
2. Agree
3. Disagree (skip to COMPLAIN)
4. Strongly Disagree (skip to COMPLAIN)


BADDOC


Did this bad experience involve a doctor or doctor's staff?


1. Yes
2. No


BADDENT


Did this bad experience involve a dentist or dentist's staff?


1 ....................... Y es
2................. ... N o

BADPHARM Did this bad experience involve a pharmacist or pharmacy staff?

1....................... Y es
2................. ... N o


BADPROV


Did this bad experience involve a health care provider or provider's staff
other than a doctor, dentist, or pharmacist?


1....................... Y es
2.................. ... N o


BADREFER


Did this bad experience involve getting a referral to a specialist or a
referral for treatment?


1 ....................... Y es
2................ .... N o

BADCLAIM Did this bad experience involve billing or insurance claims?

1. Yes
2. No









BADCUST Did this bad experience involve the plan's customer service or complaint
department?

1....................... Y es
2................. .... N o

BADOTHE Did this bad experience involve some part of the program that I did not
ask about?

1..................... Yes (Specify:)
2................. .... N o


COMPLAIN Did you ever register a complaint with OLDPLAN while you were on it or after you left? I am
talking about a complaint about this particular plan, not about Medicaid in general.

1. Yes
2. No Go to STIGMA

RESOLVE Please tell me whether you strongly agree, agree, disagree, or strongly
disagree with this statement: "My complaint was resolved to my
satisfaction?"

1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree

STIGMA Did you ever feel like you were treated differently than others because you were on the
Medicaid program?

1. Yes
2. No Go to DIFFERENT

STIGWHO Who was it that treated you differently?

1. A doctor or doctor's staff
2. A dentist or dentist's staff
3. A pharmacist or pharmacy staff
4. A health care provider other than a doctor, dentist, or
pharmacist
5. Someone else?

STIGMADE Can you tell me about that experience?









OLDCHOIC Did you choose to become enrolled in OLDPLAN, or were you assigned to it by
Medicaid?

1. Ichoseit
2. I was assigned to it

NEWCHOIC And how about NEWPLAN? Did you choose NEWPLAN, or were you assigned to it?

1. Ichoseit
2. I was assigned to it


USEDPLAN Have you had any doctor's appointments, medical procedures, or medical services, or
have you gotten any prescriptions using NEWPLAN?

1. Yes
2. No (skip to OLDRATE)

DIFFEREN Now I'm going to ask you to compare some parts of OLDPLAN and NEWPLAN. I want
you to tell me which plan you feel is better, or if you feel they are the same.

DIFFPCP Which plan do you feel offers a better choice of primary care doctors: OLDPLAN or
NEWPLAN, or are they equally good?

1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFSPEC Which plan do you feel offers a better choice of specialist doctors: OLDPLAN or
NEWPLAN, or are they equally good?

1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFDENT Which plan do you feel offers a better choice of dentists: OLDPLAN or NEWPLAN, or
are they equally good?

1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFMENT Which plan do you feel offers a better mental and emotional health benefits: OLDPLAN
or NEWPLAN, or are they equally good?

1. OLDPLAN
2. NEWPLAN
3. No Difference









DIFFSHCN


Which plan do you feel is better for people with special health needs or with a serious
illness:


1. OLDPLAN
2. NEWPLAN
3. No Difference


DIFFMEDS


Which plan do you feel is better for people who need a lot of prescription medicines?


1. OLDPLAN
2. NEWPLAN
3. No Difference


DIFFPOOR


Which plan do you feel is better for people who need to pay as little as little money as
possible for their health care?


1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFLANG For people who prefer to speak another language with their health care providers?

1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFCOUR Would you say that overall you were treated with more courtesy in NEWPLAN or in
OLDPLAN?

1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFAPPT Would you say that it is easier to get an appointment in NEWPLAN or in OLDPLAN?


1. OLDPLAN
2. NEWPLAN
3. No Difference

DIFFOTHE Besides the differences we have just talked about, is there any other way that you feel one
plan is better than the other?
(describe the difference and code which plan is better)

1. OLDPLAN
2. NEWPLAN
3. No Difference








OLDRATE


NEWRATE


Ok. I'd like you to rate the OLDPLAN health plan overall using any number between 0 and 10.
Zero is for the worst health plan possible, and ten is for the best health plan possible. What is
your rating of OLDPLAN?
Interviewer: Record rating in whole numbers only.

If USEDPLAN = 2 or -8, skip to DEMOINTR. (Next question asked only of those who
have used their new plan.)

Now I'd like you to rate the NEWPLAN health plan overall using any number between 1 and 10.
Zero is for the worst health plan possible, and ten is for the best health plan possible. What is
your rating of NEWPLAN?
Interviewer: Record rating in whole numbers only.


DEMOINTR Ok. We are almost done with the survey. I just have a few more questions to ask you.
(Note: In order to ensure comparability i ith the Medicaid HMO surveys being conducted by AHCA,
the demographic questionsfor this survey were taken from the CAHPS 2.0, except where noted. The
response categories and the questions themselves are identical to those used in CAHPS. However, for
some items an introduction to the questions was added in an attempt to make respondents more
comfortable i/ ith the questions and the response categories offered)

HEALTH In general, how would you rate your overall health now?


Excellent
Very Good
Good
Fair
Poor


DOB


What is your date of birth? Programmer -This can be entered as a single field, or as a
separate field for month, day, and year. Use whichever format is easiest for SAS
programming.


Note CAHPS does not ask for DOB. It asks for the respondent to indicate which of a list of age
ranges he or she falls into.

SEX Are you male or female?

1. Male
2. Female

EDUCAT What is the highest grade or level of school that you have completed?
1. 8th grade or less
2. Some high school, but did not graduate
3. High school graduate or GED
4. Some college or 2-year degree
5. 4-year college graduate
6. More than 4-year college degree









Are you of Hispanic or Latino origin or descent?


1. Hispanic or Latino
2. Not Hispanic or Latino

RACE I am going to read you a list of race categories, and I'd like you to tell me which one or ones you think
describe you best. Just so you know, the reason I'm asking you about this is because the researchers want
to make sure they have gathered the opinions of enough people from all different races and ethnicities.

Here is the list. Tell me yes or no for each category. Are you:


RACEWH White 1. Yes 2. No
RACEBL Black or African American 1. Yes 2. No
RACEAS Asian 1. Yes 2. No
RACEHAW Native Hawaiian or other Pacific Islander 1. Yes 2. No
RACEIND American Indian or Alaska Native 1. Yes 2. No
(Note: Race categories are identical to those from the CAHPS 2.0, but the question introduction is modified.)

LANGUAGE What language do you mainly speak at home?
1. English
2. Spanish
3. Some other language (please print)


OUT Ok. That's all the questions I have for you. Thank you very much for your time.


ETHNIC








Demographic Characteristics of Plan Switchers Overall and by Switch Group


Switchers Overall Group 1 Group 2 Grou 3
HMO to MediPass MediPass to HMO HMO to HMO Tests of Significance
N=353
N=159 N=77 N=117


N % ors N %ors N % ors N %ors X2 r p
F
Self-Assessed Overall Health
Excellent 44 12.61% 16 10.19% 13 17.11% 15 12.93%
Very Good 63 18.05% 28 17.83% 17 22.37% 18 15.52%
Good 103 29.51% 43 27.39% 18 23.68% 42 36.21% 8.98 0.344
Fair 76 21.78% 38 24.20% 13 17.11% 25 21.55%
Poor 63 18.05% 32 20.38% 15 19.74% 16 13.79%

Mean Age 41.83 16.38 42.77 15.77 38.66 14.56 42.63 18.10 1.85 0.158

Sex
Male 58 16.43% 32 20.13% 12 15.58% 14 11.97%
3.32 0.190
Female 295 83.57% 127 79.87% 65 84.42% 103 88.03%

Highest School Grade Completed
8th Grade or Less 27 7.74% 11 6.96% 4 5.33% 12 10.34%
Some High School, but Didn't Graduate 72 20.63% 30 18.99% 15 20.00% 27 23.28%
High School Graduate, or GED 135 38.68% 61 38.61% 33 44.00% 41 35.34% 5 0834
5.78 0.834
Some College or 2-Year Degree 94 26.93% 44 27.85% 18 24.00% 32 27.59%
4-Year College Degree 13 3.72% 8 5.06% 3 4.00% 2 1.72%
Post Baccalaureate or Beyond 8 2.29% 4 2.53% 2 2.67% 2 1.72%

Hispanic or Latino Origin or Descent
Yes 113 32.47% 54 34.84% 21 27.27% 38 32.76%
1.35 0.509
No 235 67.53% 101 65.16% 56 72.73% 78 67.24%

Race
(choose all that apply)
White 191 54.11% 97 61.01% 42 54.55% 52 44.44% 7.45 0.024
Black or African-American 115 32.58% 38 23.90% 29 37.66% 48 41.03% 10.16 0.006


Table 1:










Switchers Overall Group 1 Group 2 Grou 3
HMO to MediPass MediPass to HMO HMO to HMO Tests of Significance
N=353
N=159 N=77 N=117


N % ors N %ors N % ors N %ors 2or p
F
Asian 8 2.27% 3 1.89% 1 1.30% 4 3.42% N/A N/A
Native American 12 3.40% 4 2.52% 1 1.30% 7 5.98% N/A N/A
Other 57 16.15% 29 18.24% 7 9.09% 21 17.95% 3.63 0.163

Primary Language
English 266 75.57% 114 72.15% 61 79.22% 91 77.78%
Spanish 78 22.16% 39 24.68% 15 19.48% 24 20.51% 2.34 0.673
Other 8 2.27% 5 3.16% 1 1.30% 2 1.71%










Table 2: Reasons for Switching Managed Care Arrangements: Overall and by Switch Group


Switchers Group 1 Group 2 Group 3
HMO to MediPass to HMO to Tests of
Overall
O e MediPass HMO HMO Significance
N=353
N=159 N=77 N=117

N %ors N % or s N %ors N % ors 2 or P

Reasons for Switch (choose all that apply)

A specific provider was not on old plan
Strongly Agree 106 31.36% 53 35.33% 15 20.55% 38 33.04%
Agree 129 38.17% 63 42.00% 30 41.10% 36 31.30% 13.5
13.85 0.031
Disagree 76 22.49% 28 18.67% 18 24.66% 30 26.09%
Strongly Disagree 27 7.99% 6 4.00% 10 13.70% 11 9.57%


Better overall selection of providers in new plan
Strongly Agree 107 31.85% 55 36.18% 22 29.73% 30 27.27%
Agree 154 45.83% 69 45.39% 31 41.89% 54 49.09% .
4.71 0.582
Disagree 59 17.56% 22 14.47% 17 22.97% 20 18.18%
Strongly Disagree 16 4.76% 6 3.95% 4 5.41% 6 5.45%


Old plan too restrictive regarding provider choice and visits
Strongly Agree 92 26.90% 51 33.33% 15 19.48% 26 23.21%
Agree 125 36.55% 56 36.60% 28 36.36% 41 36.61%
8.40 0.210
Disagree 106 30.99% 38 24.84% 30 38.96% 38 33.93%
Strongly Disagree 19 5.56% 8 5.23% 4 5.19% 7 6.25%

Better benefits/features of new plan
Strongly Agree 110 32.26% 50 32.47% 28 36.84% 32 28.83%
Agree 160 46.92% 73 47.40% 35 46.05% 52 46.85%
4.09 0.664
Disagree 61 17.89% 26 16.88% 10 13.16% 25 22.52%
Strongly Disagree 10 2.93% 5 3.25% 3 3.95% 2 1.80%









Switchers Group 1 Group 2 Group 3
HMO to MediPass to HMO to Tests of
Overall
MediPass HMO HMO Significance
N=353
N=159 N=77 N=117

N % ors N %ors N %ors N % ors 2 or F P



Thought new plan would result in less out-of-pocket costs
Strongly Agree 42 13.13% 19 13.29% 12 16.67% 11 10.48%
Agree 113 35.31% 56 39.16% 27 37.50% 30 28.57% 6.2
6.42 0.377
Disagree 140 43.75% 59 41.26% 28 38.89% 53 50.48%
Strongly Disagree 25 7.81% 9 6.29% 5 6.94% 11 10.48%


Wanted to be on same plan as another family member
Strongly Agree 24 6.94% 8 5.13% 5 6.49% 11 9.73%
Agree 68 19.65% 34 21.79% 12 15.58% 22 19.47% 50
5.30 0.506
Disagree 215 62.14% 100 64.10% 48 62.34% 67 59.29%
Strongly Disagree 39 11.27% 14 8.97% 12 15.58% 13 11.50%


More convenient location of providers and facilities in new plan
Strongly Agree 84 24.21% 45 29.03% 14 18.18% 25 21.74%
Agree 156 44.96% 70 45.16% 33 42.86% 53 46.09%
6.97 0.324
Disagree 94 27.09% 36 23.23% 25 32.47% 33 28.70%
Strongly Disagree 13 3.75% 4 2.58% 5 6.49% 4 3.48%


Had a bad experience with old plan or heard of a bad experience
Strongly Agree 45 13.24% 25 16.23% 7 9.21% 13 11.82%
Agree 52 15.29% 28 18.18% 8 10.53% 16 14.55% 6.3
6.63 0.357
Disagree 203 59.71% 87 56.49% 50 65.79% 66 60.00%
Strongly Disagree 40 11.76% 14 9.09% 11 14.47% 15 13.64%









Switchers Group 1 Group 2 Group 3
HMO to MediPass to HMO to Tests of
Overall
vel MediPass HMO HMO Significance
N=353
N=159 N=77 N=117

N % or s N % or s N %ors N %ors 2 or F P


(For those who indicated they switched plans because a specific provider was
not on the old plan) Provider type
Primary care provider 108 46.55% 54 46.96% 18 40.00% 36 50.00%
Specialist 74 31.90% 42 36.52% 13 28.89% 19 26.39% 6.7
6.57 0.362
Dentist 23 9.91% 7 6.09% 7 15.56% 9 12.50%
Other 27 11.64% 12 10.43% 7 15.56% 8 11.11%




(For those who indicated they switched plans due to a negative experience
with the old plan) Source of Negative Experience with the Old Plan(choose
all that apply)
A doctor or doctor's staff 54 56.25% 30 56.60% 8 57.14% 16 55.17% 0.02 0.990
A dentist or dentist's staff 17 17.89% 10 19.23% 4 26.67% 3 10.71% 1.83 0.400

2.00 0.368
A pharmacist, pharmacist's staff, or prescription problem 27 28.13% 18 33.96% 3 21.43% 6 20.69%
Another type of health care provider or staff 43 44.79% 25 47.17% 7 50.00% 11 37.93% 0.83 0.661
Getting a referral 63 67.02% 37 69.81% 9 69.23% 17 60.71% 0.72 0.698
Billing or claims 43 45.74% 26 49.06% 4 33.33% 13 44.83% 0.99 0.610
Plan's customer service or complaint department 40 42.11% 19 35.85% 7 50.00% 14 50.00% 1.92 0.382
Other 27 28.42% 18 34.62% 3 21.43% 6 20.69% 2.17 0.338

Filed one or more complaints with old plan 37 10.57% 19 11.95% 6 7.79% 12 10.53% 0.95 0.622

(For those who had filed a complaint)
Complaint resolved satisfactorily
Strongly Agree 6 16.67% 5 26.32% N/A N/A 1 8.33%
Agree 8 22.22% 5 26.32% 1 20.00% 2 16.67%
4.260 0.642
Disagree 6 16.67% 3 15.79% 1 20.00% 2 16.67%
Strongly Disagree 16 44.44% 6 31.58% 3 60.00% 7 58.33%











Table 3: Perceived Differences between Old Plan and New Plan: Overall and by Switch Group


SGroup 1 Group 2 Group 3 Tests of
Switchers Overall Otp Tests of
Swice a HMO to MediPass MediPass to HMO HMO to HMO Sce
N=353 Significance
N=159 N=77 N=117

N % ors N % ors N % or s N %ors 2 or F p

Better Choice of Primary Care Doctors
Old plan 24 8.86% 13 10.32% 8 13.79% 3 3.45%
New plan 149 54.98% 69 54.76% 28 48.28% 52 59.77% 5.72 0.221
No Difference 98 36.16% 44 34.92% 22 37.93% 32 36.78%

Better Choice of Specialist Doctors
Old plan 20 7.72% 9 7.50% 6 10.71% 5 6.02%
New plan 150 57.92% 71 59.17% 31 55.36% 48 57.83% 1.18 0.881
No Difference 89 34.36% 40 33.33% 19 33.93% 30 36.14%

Better Choice of Dentists
Old plan 27 12.00% 16 16.00% 5 9.26% 6 8.45%
New plan 113 50.22% 37 37.00% 36 66.67% 40 56.34% 14.39 0.006
No Difference 85 37.78% 47 47.00% 13 24.07% 25 35.21%

Better mental/emotional health benefits
Old plan 19 8.64% 12 11.65% 4 8.00% 3 4.48%
New plan 104 47.27% 52 50.49% 23 46.00% 29 43.28% 4.87 0.301
No Difference 97 44.09% 39 37.86% 23 46.00% 35 52.24%

Better for people with special health care
needs or illnesses
Old plan 25 9.84% 11 9.24% 11 20.00% 3 3.75%
New plan 139 54.72% 71 59.66% 22 40.00% 46 57.50% 12.85 0.012
No Difference 90 35.43% 37 31.09% 22 40.00% 31 38.75%









Switchers Overall roup 1 Group 2 Group 3
Sw s O l HMO to MediPass MediPass to HMO HMO to HMO f
N=353 Significance
N=159 N=77 N=117

N % ors N % ors N % or s N %ors 2 r F p
Better for people who need many
prescriptions
Old plan 33 12.18% 13 10.24% 14 24.14% 6 6.98%
New plan 140 51.66% 77 60.63% 21 36.21% 42 48.84% 17.37 0.002
No Difference 98 36.16% 37 29.13% 23 39.66% 38 44.19%

Better for people who "need to pay as little
as possible" for their health care
Old plan 22 8.87% 12 10.08% 9 16.07% 1 1.37%
New plan 141 56.85% 65 54.62% 30 53.57% 46 63.01% 9.12 0.058
No Difference 85 34.27% 42 35.29% 17 30.36% 26 35.62%

Better for non English speakers
Old plan 12 5.58% 5 5.26% 4 8.16% 3 4.23%
New plan 81 37.67% 33 34.74% 16 32.65% 32 45.07% 3.10 0.0542
No Difference 122 56.74% 57 60.00% 29 59.18% 36 50.70%

Overall more courteous
Old plan 26 9.25% 14 10.94% 7 11.29% 5 5.49%
New plan 131 46.62% 58 45.31% 25 40.32% 48 52.75% 3.74 0.442
No Difference 124 44.13% 56 43.75% 30 48.39% 38 41.76%

Easier to get an appointment
Old plan 26 9.42% 8 6.30% 13 21.31% 5 5.68%
New plan 151 54.71% 77 60.63% 22 36.07% 52 59.09% 17.84 0.001
No Difference 99 35.87% 42 33.07% 26 42.62% 31 35.23%

On a scale of 0 to 10, overall rating of old
plan 6.13 2.86 5.92 3.03 6.48 2.69 6.19 2.74 0.96 0.38
On a scale of 0 to 10, overall rating of new
plan 8.21 2.27 8.39 2.18 7.86 2.56 8.18 2.18 1.18 0.31













Table 4: Sources of Information About New Plan, Medicaid Bias, and Health Plan Choice


Switchers Group 1 Group 2 Group 3
HMO to MediPass to HMO to Tests of
Overall
val MediPass HMO HMO Significance
N=353
N=159 N=77 N=117

N % ors N %ors N % ors N % ors X2 or F P

Source(s) of Information about New Plan
(choose all that apply)
Telephone call from new plan 72 20.87% 21 13.64% 23 29.87% 28 24.56% 9.60 0.008
Mail from new plan 167 48.27% 77 49.68% 44 58.67% 46 39.66% 6.82 0.033
Friend or family member 103 29.26% 47 29.56% 21 27.27% 35 30.17% 0.20 0.905
AHCA or DCF 92 26.51% 42 26.75% 19 25.33% 31 26.96% 0.07 0.966
Advertisment about new plan 79 22.70% 26 16.56% 24 32.00% 29 25.00% 7.42 0.024
In-person visit
Doctor or Clinic 114 32.39% 72 45.57% 20 25.97% 22 18.80% 23.84 0.001
Work
Other 104 29.55% 46 28.93% 25 32.89% 33 28.21% 0.54 0.764


0.40 0.820
Reported Being treated differently due to Medicaid enrollment 90 25.57% 43 27.04% 18 23.38% 29 25.00%40 82



Type of Provider who showed bias (For those who reported they had
been treated differently because of Medicaid enrollment
A doctor or doctor's staff 44 50.00% 24 58.54% 11 61.11% 9 31.03%
A dentist or dentist's staff 4 4.55% 2 11.11% 2 6.90%
A pharmacist or pharmacist's staff 6 6.82% 3 7.32% 1 5.56% 2 6.90% 11.98 0.15

Health provider (non-specfic) or more than one category 8 9.09% 2 4.88% 1 5.56% 5 17.24%
Other 26 29.55% 12 29.27% 3 16.67% 11 37.93%









Switchers Group 1 Group 2 Group 3
HMO to MediPass to HMO to Tests of
Overall
MediPass HMO HMO Significance
N=353
N N=159 N=77 N=117

N % ors N %ors N % ors N % ors X2 or F p
Respondent chose/was assigned to old plan
chose 159 46.49% 54 35.29% 40 52.63% 65 57.52%
14.39 0.001
was assigned 183 53.51% 99 64.71% 36 47.37% 48 42.48%

Respondent chose/was assigned to new plan
chose 312 88.64% 131 82.91% 70 90.91% 111 94.87%
10.05 0.007
was assigned 40 11.36% 27 17.09% 7 9.09% 6 5.13%


Respondent has use new plan for medical care or prescription drug
Yes 289 82.10% 134 84.81% 63 81.82% 92 78.63%
1.75 0.417
No 63 17.90% 24 15.19% 14 18.18% 25 21.37%




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