Patients’ Perceptions of Integrated Care Among Medicare Beneficiaries by Level of Need for Health Services

Abstract

Requirements for integrating care across providers, settings, and over time increase with patients’ needs. Health care providers’ ability to offer care that patients experience as integrated may vary among patients with different levels of need. We explore the variation in patients’ perceptions of integrated care among Medicare beneficiaries based on the beneficiary’s level of need using ordinary least square regression for each of four high-need groups: beneficiaries (a) with complex chronic conditions, (b) with frailties, (c) below 65 with disability, and (d) with any (of the first three) high needs. We control for beneficiary demographics and other factors affecting integrated care, and we conduct sensitivity analyses controlling for multiple individual chronic conditions. We find significant positive associations with level of need for provider support for self-directed care and medication and home health management. Controlling for multiple individual chronic conditions reduces effect sizes and number of significant relationships.

Keywords

high needs Medicare integrated care patient perceptions

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References

2015 Medicare Current Beneficiary Survey Data User’s Guide: General Information. (2017). Centers for Medicare & Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Codebooks.html

Benjamini

Yekutieli

(2001). The control of the false discovery rate in multiple testing under dependency. Annals of Statistics, 29(4), 1165–1188.

Berry

A. B. L.

Lim

Hartzler

A. L.

Hirsch

Wagner

E. H.

Ludman

Ralston

J. D.

(2017). How values shape collaboration between patients with multiple chronic conditions and spousal caregivers. In Proceedings of the 2017 CHI conference on human factors in computing systems (pp. 5257–5270). Association for Computing Machinery. https://doi.org/10.1145/3025453.3025923

Berry

L. L.

Rock

B. L.

Smith Houskamp

Brueggeman

Tucker

(2013). Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clinic Proceedings, 88(2), 184–194. https://doi.org/10.1016/j.mayocp.2012.10.016

Blumenthal

Abrams

M. K.

(2016). Tailoring complex care management for high-need, high-cost patients. JAMA, 316(16), 1657–1658. https://doi.org/10.1001/jama.2016.12388

Blumenthal

Chernof

Fulmer

Lumpkin

Selberg

(2016). Caring for high-need, high-cost patients—An urgent priority. New England Journal of Medicine, 375(10), 909–911. https://doi.org/10.1056/NEJMp1608511

Bogard

Murry

V. M.

Alexander

C. M.

, & National Academy of Medicine (U.S.). (2017). Perspectives on health equity and social determinants of health. https://nam.edu/wp-content/uploads/2017/12/Perspectives-on-Health-Equity-and-Social-Determinants-of-Health.pdf

Brown

R. S.

Peikes

Peterson

Schore

Razafindrakoto

C. M.

(2012). Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Affairs (Project Hope), 31(6), 1156–1166. https://doi.org/10.1377/hlthaff.2012.0393

Carlin

C. S.

Christianson

J. B.

Keenan

Finch

(2012). Chronic illness and patient satisfaction. Health Services Research, 47(6), 2250–2272. https://doi.org/10.1111/j.1475-6773.2012.01412.x

10.

Carver

C. S.

Scheier

M. F.

Segerstrom

S. C.

(2010). Optimism. Clinical Psychology Review, 30(7), 879–889. https://doi.org/10.1016/j.cpr.2010.01.006

11.

Chen

J. G.

Zou

Shuster

(2017). Relationship between patient satisfaction and physician characteristics. Journal of Patient Experience, 4(4), 177–184. https://doi.org/10.1177/2374373517714453

12.

Fenton

J. J.

Jerant

A. F.

Bertakis

K. D.

Franks

(2012). The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Archives of Internal Medicine, 172(5), 405–411. https://doi.org/10.1001/archinternmed.2011.1662

13.

Friedberg

M. W.

Edelen

M. O.

Hirshman

Kerrissey

M. J.

Basile

A. M.

Tietschert

M. V.

Elliot

M. N.

Singer

S. J.

(2019). Development and psychometric analysis of the revised patient perceptions of integrated care survey. Medical Care Research and Review, 78(1), 68–76. https://doi.org/10.1177/1077558719842951

14.

Friedberg

M. W.

Safran

D. G.

Schneider

E. C.

(2012). Satisfied to death: A spurious result? Archives of Internal Medicine, 172(14), 1110–1114. https://doi.org/10.1001/archinternmed.2012.2060

15.

Fryer

A.-K.

Friedberg

M. W.

Thompson

R. W.

Singer

S. J.

(2016). Achieving care integration from the patients’ perspective: Results from a care management program. Healthcare (Amsterdam, Netherlands), 4(1), 36–44. https://doi.org/10.1016/j.hjdsi.2015.12.006

16.

Fryer

A.-K.

Friedberg

M. W.

Thompson

R. W.

Singer

S. J.

(2017). Patient perceptions of integrated care and their relationship to utilization of emergency, inpatient and outpatient services. Healthcare (Amsterdam, Netherlands), 5(4), 183–193. https://doi.org/10.1016/j.hjdsi.2016.12.005

17.

Greene

Hibbard

J. H.

(2012). Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine, 27(5), 520–526. https://doi.org/10.1007/s11606-011-1931-2

18.

Hayes

Salzberg

McCarthy

Radley

Abrams

Shah

Anderson

(2016). High-need, high-cost patients: Who are they and how do they use health care? [Issue brief] (pp. 1–14). https://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-who-are-they-and-how-do-they-use

19.

Hochman

Asch

S. M.

(2017). Disruptive models in primary care: Caring for high-needs, high-cost populations. Journal of General Internal Medicine, 32(4), 392–397. https://doi.org/10.1007/s11606-016-3945-2

20.

Hopman

de Bruin

S. R.

Forjaz

M. J.

Rodriguez-Blazquez

Tonnara

Lemmens

L. C.

Onder

Baan

C. A.

Rijken

(2016). Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review. Health Policy (Amsterdam, Netherlands), 120(7), 818–832. https://doi.org/10.1016/j.healthpol.2016.04.002

21.

Jean-Baptiste

O’Malley

Shah

(2017). Population segmentation and targeting of health care resources: Findings from a literature review (Working paper, 58). Mathematica Policy Research.

22.

Joynt

K. E.

Figueroa

J. F.

Beaulieu

Wild

R. C.

Orav

E. J.

Jha

A. K.

(2017). Segmenting high-cost Medicare patients into potentially actionable cohorts. Healthcare (Amsterdam, Netherlands), 5(1–2), 62–67. https://doi.org/10.1016/j.hjdsi.2016.11.002

23.

Kerrissey

M. J.

Clark

J. R.

Friedberg

M. W.

Jiang

Fryer

A. K.

Frean

Shortell

S. M.

Ramsay

P. P.

Casalino

L. P.

Singer

S. J.

(2017). Medical group structural integration may not ensure that care is integrated, from the patient’s perspective. Health Affairs, 36(5), 885–892. https://doi.org/10.1377/hlthaff.2016.0909

24.

Kim

D. H.

Schneeweiss

Glynn

R. J.

Lipsitz

L. A.

Rockwood

Avorn

(2018). Measuring frailty in Medicare data: Development and validation of a claims-based frailty index. The Journals of Gerontology. Series A, 73(7), 980–987. https://doi.org/10.1093/gerona/glx229

25.

Kupfer

J. M.

Bond

E. U.

(2012). Patient satisfaction and patient-centered care: Necessary but not equal. JAMA, 308(2), 139–140. https://doi.org/10.1001/jama.2012.7381

26.

Liss

D. T.

Chubak

Anderson

M. L.

Saunders

K. W.

Tuzzio

Reid

R. J.

(2011). Patient-reported care coordination: Associations with primary care continuity and specialty care use. Annals of Family Medicine, 9(4), 323–329. https://doi.org/10.1370/afm.1278

27.

Long

Abrams

Milstein

Anderson

Apton

K. L.

Dahlberg

M. L.

Whicher

(Eds.). (2017). Effective care for high-need patients. National Academy of Medicine. https://nam.edu/HighNeeds/

28.

Lumley

(2018). Survey: Analysis of complex survey samples [R package version 3.35].

29.

Maeng

D. D.

Martsolf

G. R.

Scanlon

D. P.

Christianson

J. B.

(2012). Care coordination for the chronically ill: Understanding the patient’s perspective. Health Services Research, 47(5), 1960–1979. https://doi.org/10.1111/j.1475-6773.2012.01405.x

30.

Martínez-González

N. A.

Berchtold

Ullman

Busato

Egger

(2014). Integrated care programmes for adults with chronic conditions: A meta-review. International Journal for Quality in Health Care, 26(5), 561–570. https://doi.org/10.1093/intqhc/mzu071

31.

McCarthy

Ryan

Klein

(2015). Models of care for high-need, high-cost patients: An evidence synthesis (Issue Brief No. 31, pp. 1–19). The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2015/oct/models-care-high-need-high-cost-patients-evidence-synthesis

32.

Mossialos

Osborn

Roland

Abrams

Amelung

Balicer

Battersby

Anderson

(2017). Designing a high-performing health care system for patients with complex needs: Ten recommendations for policymakers. The Commonwealth Fund and the London School of Economics and Political Science. https://www.commonwealthfund.org/publications/fund-reports/2017/sep/designing-high-performing-health-care-system-patients-complex

33.

Ory

M. G.

Ahn

Jiang

Smith

M. L.

Ritter

P. L.

Whitelaw

Lorig

(2013). Successes of a national study of the Chronic Disease Self-Management Program: Meeting the triple aim of health care reform. Medical Care, 51(11), 992–998. https://doi.org/10.1097/MLR.0b013e3182a95dd1

34.

Parker

J. L.

Regan

J. F.

Petroski

(2014). Beneficiary activation in the Medicare population. Medicare & Medicaid Research Review, 4(4), E1–E14. https://doi.org/10.5600/mmrr.004.04.b02

35.

Rocks

Berntson

Gil-Salmerón

Kadu

Ehrenberg

Stein

Tsiachristas

(2020). Cost and effects of integrated care: A systematic literature review and meta-analysis. The European Journal of Health Economics, 21(8), 1211–1221. https://doi.org/10.1007/s10198-020-01217-5

36.

Scheier

Carver

Bridges

(1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063–1078.

37.

Segal

J. B.

Chang

H.-Y.

Walston

J. D.

Carlson

M. C.

Varadhan

(2017). Development of a claims-based frailty indicator anchored to a well-established frailty phenotype. Medical Care, 55(7), 716–722. https://doi.org/10.1097/MLR.0000000000000729

38.

Simpson

K. N.

Seamon

B. A.

Hand

B. N.

Roldan

C. O.

Taber

D. J.

Moran

W. P.

Simpson

A. N.

(2018). Effect of frailty on resource use and cost for Medicare patients. Journal of Comparative Effectiveness Research, 7(8), 817–825. https://doi.org/10.2217/cer-2018-0029

39.

Singer

S. J.

Burgers

Friedberg

Rosenthal

M. B.

Leape

Schneider

(2011). Defining and measuring integrated patient care: Promoting the next frontier in health care delivery. Medical Care Research and Review, 68(1), 112–127. https://doi.org/10.1177/1077558710371485

40.

Singer

S. J.

Friedberg

M. W.

Kiang

M. V.

Dunn

Kuhn

D. M.

(2013). Development and preliminary validation of the Patient Perceptions of Integrated Care survey. Medical Care Research and Review, 70(2), 143–164. https://doi.org/10.1177/1077558712465654

41.

Tricco

A. C.

Antony

Ivers

N. M.

Ashoor

H. M.

Khan

P. A.

Blondal

Ghassemi

MacDonald

Chen

M. H.

Ezer

L. K.

Straus

S. E.

(2014). Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: A systematic review and meta-analysis. Canadian Medical Association Journal, 186(15), E568–E578. https://doi.org/10.1503/cmaj.140289

42.

Turner

R. M.

Lorig

Greenberg

DeVries

A. R.

(2018). Evaluation of a diabetes self-management program: Claims analysis on comorbid illnesses, health care utilization, and cost. Journal of Medical Internet Research, 20(6), Article e6207. https://doi.org/10.2196/jmir.9225

43.

Tzelepis

Sanson-Fisher

R. W.

Zucca

A. C.

Fradgley

E. A.

(2015). Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment. Patient Preference and Adherence, 9, 831–835. https://doi.org/10.2147/PPA.S81975

44.

Xiao

Barber

J. P.

(2008). The effect of perceived health status on patient satisfaction. Value in Health, 11(4), 719–725. https://doi.org/10.1111/j.1524-4733.2007.00294.x

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