Results from an Evaluation of the Minnesota Disability Health Options (MnDHO) Program: Survey and Focus Group Findings

Phillip W. Beatty, PhDThilo Kroll, PhDPei-Shu Ho, PhD

Susan E. Palsbo, PhDNRH Center for Health & Disability Research

Washington, DC

Minnesota Disability Health Options (MnDHO)

• Specialized managed Medicaid plan

• Working-age adults with disabilities

• 50%+ are dual eligibles• Voluntary enrollment• Started September, 2001• Currently 205+ enrollees

Principles of Service Delivery

• Comprehensive care focus • Consumer self-direction• Service coordination and integration• Disability competent service delivery• Accessibility of services and facilities• Promotion of independent living

Study Objective

• To determine the extent to which the MnDHO/AXIS program enhances the quality of health care for enrolless with disabilities, as well as their health care satisfaction and self-direction

Preliminary Findings From Mixed-Methods Evaluation

• Multiple external evaluators• Longitudinal CAHPS®-based survey

– At MnDHO/AXIS enrollment– 1 year post-enrollment

• Focus groups – MnDHO/AXIS enrollees– Eligible people who chose not to enroll

Longitudinal Survey

• 100 MnDHO/AXIS participants – 78 baseline; 35 enrollees have completed

baseline and follow-up surveys. • Baseline

– Health care experiences in the year before enrollment.

• Follow-up – Health care experiences in MnDHO/AXIS.

Survey Content

• General satisfaction• Care coordination experience• Access to a wide variety of health and long-term-care

services• Self-directed care• Quality of interactions with health care providers• Quality of interactions with MA or AXIS staff

Focus Groups

• October, 2002• 2 focus groups with MnDHO/AXIS enrollees

(n=11)• 2 focus groups with Fee-For-Service Medical

Assistance program enrollees (n=11)• Content areas consistent with survey

General Satisfaction with Health Care Services. Given a 5-point scale ranging from 1 to 5, how would you rate the health care services you have received in the year before / after you enrolled in AXIS/UCare Complete?

6

91

3

0102030405060708090

100

% o

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espo

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Same Greater in MnDHO Less in MnDHO

General satisfation with health care services

General Satisfaction with Primary Care Doctors. Given a 5-point scale ranging from 1 to 5, how would you rate the primary care doctor you saw in the year before / after you enrolled in AXIS/UCare Complete?

12

70

18

0102030405060708090

100

% o

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espo

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Same Greater in MnDHO Less in MnDHO

Satisfaction with Primary Care Doctor

Focus Group Statement

“[AXIS] knows the [doctors] that deal in disabilities, so they kind of direct us to go to those [doctors] if they’re available……Because on our own, I don’t think we would know which ones, unless we went to them all.”

Care Coordination. In the year before / after you enrolled in AXIS/UCare Complete, did anyone help manage the health care services you received from different doctors, nurses, therapists, PCAs,or equipment providers?

12

82

6

0102030405060708090

100

% o

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espo

nden

ts

Both Only in MnDHO Not in MnDHO

Care coordination

Focus Group Statements

• The fee-for-service experience:• “I spend most of my time on the phone calling people,

setting up appointments, or trying to get services myself, and that is very tiring. I get exhausted because I do have MS.”

• “Our experience was so bad we had to hire our own coordinator. It seems like if the person is stable……, people don’t return their calls, people don’t seem to care……”

Focus Group Statements

• The MnDHO / AXIS Experience:– “She’ll (health coordinator) line me up with my

appointments and stuff. She’ll find my therapists and my physical equipment…, all that stuff.”

– “My stress level has been relieved somewhat. I’m able to focus on more vocational and future issues, as opposed to the day-to-day healthcare issues……”

Self-direction in health care. In the year before / after you enrolled in AXIS/UCare Complete, were you involved as much as you wanted in making decisions about your health care?

5044

6

0102030405060708090

100

% o

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Both Only in MnDHO Only out of MnDHO

Self-direction in health care

Focus Group Statement

“My healthcare coordinator, she always involves me. It is our lives. They can give us all the information, but ultimately it comes down to us, what we want to do…... it comes to us making the final decision…... The healthcare coordinators are always there to give you the pros and cons.”

Access: Receiving Service Every Time It Is Needed

797270

83819390899697

0102030405060708090

100

Primary Care Specialist MedicalEquipment

Rehab Mental Health

% o

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espo

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Out of MnDHO In MnDHO

Conclusions

• The MnDHO Model appears to meet its goal of effective care coordination

• AXIS/Ucare appear to work with disability competent providers

• People with disabilities are satisfied with their involvement in care decision processes

• The evaluation is ongoing• Cost-effectiveness has yet to be determined