Consumer Direction and Managed Long-Term Care:  Are They Compatible?
Kevin J. Mahoney, Ph.D.  (Facilitator)
National Program Director, Cash and Counseling Demonstration and Evaluation (CCDE)
RoAnne Chaney
Senior Program Office, Center for Health Care Strategies
Marc Cohen, Ph.D.
Vice President, LifePlans, Inc.
Rick Surpin
President, Independence Care System

Consumer Direction and Managed Long-Term Care:  Are They Compatible?
Kevin J. Mahoney, Ph.D., Mark R. Meiners, Ph.D., 
Dawn M. Shoop, Ph.D., and Marie R. Squillace, Ph.D.

Cash and Counseling Demonstration and Evaluation
National Program Office
University of Maryland  Center on Aging

Design and Methods
Population Surveyed:  
MCOs Providing Capitated Managed LTC Benefits to 
Medicaid-Eligible Clients
73 Potential Respondents, 9 Found Ineligible
Instrumentation:  
Managed Care Organizational Questionnaire (MCOQ)
Consumer-Direction Questionnaire (CDQ)
Response Rate:
45 of 64  Responded to One or Both Surveys, 42 Responded to Both
70% Response Rate

Characteristics of MCOs
70% of MCOs were Part of a Larger Organization
68% of MCOs had Under 5 Years Experience with Medicaid Capitated LTC
65% of MCOs Focused on Older Adults (Broadly Defined)
21% of MCOs Focused on Multi-Special Populations

MCO Experience
Is Consumer Direction (CD) Being Discussed?  2/3 Said "Yes"
Clients Hire and Fire their Worker?  32% Said "Yes"
Clients have a Major Say but Don't Hire/Fire? 47% Said "Yes"
Clients Neither have a Major Say nor Hire/Fire: 21%
Experience with CD: 28% Good; 0% Bad; 72% Too Little

Summary and Conclusions
CD and MC Do Exist Together but New and Underdeveloped
Primary Motivations:  Consumer Satisfaction, Quality, Cost Effectiveness, Better Care Plans
Primary Concerns:  Inappropriate Choices, Administration and Management Burden, Too Complicated for Client
Consumer Choice (Major Say) More Likely than 
Consumer Direction (Hire/Fire Worker)


C & C and Managed Long-Term Care?
45% of the MCOs in the Study were Open to a C&C Approach for 
At Least Some of their Clients
Motivating Interest:
	*A Desire for Better Quality Services
	*Respect for Consumer Independence 
				More than...
					*Greater Cost Efficiency 
					*Gain Competitive Advantage

C & C and Managed Long-Term Care?
Experience with CD Did Not Predict Interest in C&C
When Previous Experience was "Good" as Opposed to 
"Too Little to Tell", MCOs were Inclined to Stand Pat.
(3) Organizational Factors Helped Predict MCOs Interest in the C&C  Option:  
(1) Larger size  (2)  Non- PACE  (3)  Not Limited to the Elderly


C & C and Managed Long-Term Care?
Fears Raised by MCOs Mirrored Fears of CCDE:  
Fraud and Abuse, Liability, Inferior Quality of Care, Training, Etc.
CCDE Preliminary Results:
Quality of Life Improves 
Budget Neutral
3 Years- No Major Fraud or Abuse Reported