Transcript Disability and Managed Care

Beyond Competency to Literacy:
Curb Cuts to Care
National Symposium on Culturally Competent
Care for Members with Disabilities
September 19-20, 2002
Sue Palsbo, PhD
NRH Center for Health & Disability Research
About NRH-CHDR
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16 years; 85% peer-reviewed grants
public domain, peer-reviewed research
interdisciplinary, mixed methods
Disability and…
...health (especially preventive services),
employment, minorities, self-directed care,
informed choice, and experiences getting care
Disability and Managed Care
• Finishing a 6-year study funded by NIDRR
– Focus groups
– 3-year longitudinal survey of people with SCI,
MS, CP, or RA
– indepth interviews of 30 “access stressed”
individuals
• Perspective of adults of working age with
physical disabilities in managed care plans
compared to fee-for-service
What Was Expected
• Drawing on findings of Medicare Risk
contracts, we expected to find better
outcomes in HMOs because of:
– emphasis on interdisciplinary care coordination
– comprehensive benefit coverage
What We Found
• Missed opportunities
• Much lower use of preventive services (e.g.,
mammograms, immunizations, counseling
on healthy behaviors)
• In HMOs, better access to primary care; less
use of specialists than ffs
• Not getting the therapies, DME, and Rx
they need, regardless of plan type
• Disparities in access for PWD rival
disparities for racial/ethnic groups
• Building barriers
Why?
– Bathrooms, scales, diagnostic equipment, examination
tables
• Inability to identify experienced and accessible
specialists
• Invisible barriers
– Health plan processes designed for an able majority
with acute needs
• Result: rapid accumulation of cascading
consequences that have adverse impacts on
physical health, mental health, and social
participation
Examples:
• Maria, 52-years old with CP, could not walk 3 blocks to her
bus stop. Husband had to take time off from work to take
Maria to her PCP so she could get referrals. Consequence:
delayed PT; mobility declined; dependence on family
increased; mental health decreased.
• Marty, 52-years old with SCI. Increasing arthritis in
shoulders needed more PT and power wheelchair to get to
work. Since not enough time had lapsed since manual
wheelchair, could not get to therapy; anticipated he would
lose his job and have to be placed in a nursing home.
Cultural Literacy
“The network of information that all competent
readers possess. It is the background
information, stored in their minds, that enables
them to take up a newspaper and read it with an
adequate level of comprehension, getting the
point, grasping the implications, relating what
they read to the unstated context which alone
gives meaning to what they read.”
--Cultural Literacy: What Every American Needs
to Know; ED Hirsch, 1987.
Disability Literacy Passports
1. Provider directory indicates providers who are
ADA compliant.
2. All pages on web site are “Bobby” approved.
3. Member information materials, especially
grievance and appeals, are available in
alternative formats for people with visual
impairments or compromised hand function.
4. Established “curb cuts” to specialists and Rx,
without requiring a face-to-face encounter with a
physician.
5. Procedures that allow a person with complex
health needs to select a specialist as a personal
physician and to direct their own care.
6. At least one claims processor is knowledgeable
and trained about the need for DME and
supplies.
7. Plan-wide quality improvement initiative that
monitors, measures, and improves the process of
care for people with complex health needs.
– Identify them
– Track their care
– Track their needs
2 Disability-Literate Health Plans
• AXIS Health Plan, Minneapolis Minnesota
(adults with physical disabilities)
• Community Medical Alliance, Boston Mass
(adults with SCI; HIV/AIDS)
• Shared features -- similar to successful
Medicare risk!
– “Plan within a plan”
– Strong member input into medical care
– Broad definition of medical necessity
(unconventional coverage)
For Further Information:
Sue Palsbo, PhD, MS
NRH Center for Health & Disability Research
1016 Sixteenth St. NW Suite 400
Washington DC 20036
(202) 466-1900
www.nrhchdr.org
[email protected]