Overall Los Angeles Riverside San Bernardino San Diego
Overall Los Angeles Riverside San Bernardino San Diego 2018 Findings from the Cal Medi. Connect Rapid Cycle Polling Project Conducted for In conjunction with By September 2018 Orange Institute for Health and Aging, University of California, San Francisco San Mateo The California Department of Health Care Services Santa Clara The SCAN Foundation
San Diego Santa Clara San Mateo Approximately half of eligible beneficiaries opted out of the program and kept their original Medicare. Those who opted out were still enrolled in Medi-Cal managed care plans for their long-term services and supports. San Bernardino Cal Medi. Connect beneficiaries received some new benefits such as care coordination and non-emergency transportation. Riverside Beneficiaries enrolled in Cal Medi. Connect had all of their medical care, ancillary services and long-term services and supports (LTSS) coordinated through one integrated managed care plan. Los Angeles Background: In 2014, California implemented a dual financial alignment demonstration called the Coordinated Care Initiative. Part of the demonstration Cal Medi. Connect (CMC), created integrated health plan options in seven counties for people eligible for both Medicare and Medi-Cal. Overall California’s Dual Financial Alignment Demonstration “Cal Medi. Connect” Orange 1
Overall Santa Clara San Mateo § Identify how CMC beneficiaries confidence and satisfaction changes over time. San Diego § Compare CMC enrollees’ level of confidence and satisfaction with beneficiaries who chose to opt out of CMC or who live in non-CMC counties. San Bernardino § Assess the confidence and satisfaction of CMC enrollees with the health services they are receiving. Riverside Objectives: To evaluate and track over time the experiences of dually eligible beneficiaries enrolled in coordinated care under CMC, compared to those who opted out and those in non-CMC counties. Los Angeles Survey Objectives Orange 2
Overall Data collection periods San Bernardino § Telephone interviews with stratified random samples of dual eligible beneficiaries in Cal Medi. Connect (CMC) counties, as well as beneficiaries in 9 non-CMC counties Riverside Survey method Los Angeles About the Surveys (1) § 2015 (includes Wave 1 in September; and Wave 2 in November) San Diego § 2016 (includes Wave 3 in April; and Wave 4 in September) § 2017 (includes Wave 5 in August) Santa Clara § 2018 (includes Wave 6 in May) Populations surveyed § 2015: CMC enrollees and opt-outs in 5 counties (Los Angeles, Riverside, San Bernardino, San Diego, and Santa Clara), and two non-CMC counties (Alameda and San Francisco) San Mateo § 2016 through 2018: CMC counties were expanded to two additional counties (San Mateo and Orange) Orange § 2017 and 2018: Non-CCI counties were expanded to include a total of 9 non-CMC counties 3
Overall § 2017: 2, 984 interviews, including 1, 781 CMC enrollees, 786 CMC opt-outs, and 417 beneficiaries in non-CMC counties. San Diego § 2016: 6, 513 interviews, including 3, 351 CMC enrollees, 2, 031 CMC opt-outs, and 1, 131 beneficiaries in non-CMC counties. San Bernardino § 2018: 2, 961 interviews, including 1, 775 CMC enrollees, 781 CMC opt-outs, and 405 beneficiaries in non-CMC counties. Riverside Sample Sizes by Survey Year Los Angeles About the Surveys (2) § 2015: 5, 002 interviews, including 2, 764 CMC enrollees, 1, 368 CMC opt-outs, and 870 beneficiaries in non-CMC counties. Santa Clara Aggregate Sample Sizes (across all years) San Mateo § 9, 671 CMC Enrollees § 2, 823 non-CMC counties Orange § 4, 966 CMC Opt-Outs 4
Overall Los Angeles Riverside San Bernardino San Diego Findings in Brief Santa Clara San Mateo Orange 5
San Diego Santa Clara San Mateo CMC enrollees’ confidence in these areas has progressively increased between 2015 and 2018; while confidence among opt-outs has remained steady. San Bernardino While confidence ratings in earlier years had been similar across enrollees and opt-outs, starting in 2017 and continuing in 2018 CMC enrollees’ confidence was higher in all three areas than the other groups. Riverside Large majorities of CMC enrollees continue to express confidence that they know how to manage their health conditions (82%), that they can get questions about their health needs answered (84%), and know who to call if they have a health need or question (89%). Los Angeles Confidence Navigating Health Care Overall Findings in Brief Orange 6
San Bernardino San Diego The satisfaction levels of CMC enrollees increased between 2015 and 2018 in all seven areas. Riverside Large majorities of CMC enrollees – ranging from 77% to 89% – report being satisfied with the health care services they are receiving in each of 7 areas tracked. Los Angeles Satisfaction with Health Care Services Overall Findings in Brief In 2018, CMC enrollees were more satisfied than opt-outs in the areas of: Santa Clara § the information they get from their health plan explaining benefits, § the way different providers work together, and Orange While in past years those who opted out were more satisfied than CMC enrollees with the amount of time spent with their doctor, by 2017 satisfaction increased to match opt outs. San Mateo § their ability to call a provider regardless of the time of day. 7
Riverside San Bernardino In 2018, the two most commonly reported problems among CMC enrollees were: a doctor they had been seeing was no longer available through their plan (16%), and they had a misunderstanding about their health care services or coverage (14%). Los Angeles Problems Encountered with Health Care Overall Findings in Brief CMC enrollees in 2018 had lower rates of reported problems than in previous years in three areas: San Diego § Had a misunderstanding about health care services or coverage (21% in 2015 down to 14% in 2018). Santa Clara § Health Plan denied treatment or referral for a service recommended by a doctor (17% in 2015 down to 13% in 2018). San Mateo Orange § A doctor they had been seeing was no longer available through their plan (23% in 2015 down to 16% in 2018). 8
San Diego Santa Clara In 2018, 22% of duals in non-CCI counties had a short (1 year or less) relationship with their doctor, this is up from 12% in 2015 and is significantly more than both CMC enrollees (16%) and opt outs (14%). San Bernardino Only 14% of opt-out beneficiaries reported that they had been seeing their personal doctor for 1 year or less, lower than CMC enrollees (16%) and non-CCI beneficiaries (22%). Riverside The percentage of both CMC enrollees that report they have been seeing their personal doctor* for a short time (1 year or less) declined significantly over the years, from 30% in 2015, down to 16% in 2018. Los Angeles Length of Time with a Personal Doctor Overall Findings in Brief San Mateo Orange * A “personal doctor” was defined in the survey as “the doctor who knows you best and can refer you to other doctors when you need to see a specialist. ” 9
San Diego Santa Clara San Mateo Almost three-quarters of CMC enrollees (65%) and opt outs (68%) with a personal care plan said it improved their care “a lot, ” compared to less than half (48%) of non-CCI dual who reported the same. San Bernardino Over half of CMC enrollees (57%) with single care managers in 2018 said that having such a manager has improved their care “a lot. ” While more opt-outs with a single care manager (63%) and non-CCI duals (71%) reported the same. Riverside The percent of CMC enrollees who reported having a single care manager and/or a personal care plan decreased from one-third in 2016 down to one quarter in 2018. The proportion of opt-outs and non-CCI duals who reported having a single care manager decreased even more, from 33% in 2016 to 20% in 2018, and 36% in 2016 to 20% in 2018, respectively. Los Angeles Reported Use of Single Care Managers and Personal Care Plans by Enrollees and Opt-outs Overall Findings in Brief Orange * A single care manager was defined in the survey as a nurse or other helper from their health plan who serves as their main point of contact and can arrange all aspects of their care. ** A personal care plan was defined in the survey as a plan designed to take into account their health goals, needs and preferences. 10
Santa Clara San Mateo More opt-outs (53%) than CMC enrollees (43%) also report using specialized equipment, such as a cane, wheelchair, scooter, or special bed. San Diego Among opt-outs, 44% of LTSS beneficiaries reported they need assistance for common daily activities. This compares to 31% among CMC enrollees. San Bernardino A slightly larger percent of opt-outs (28%) than CMC enrollees (20%) say they have been in a hospital overnight in the past 12 months. Riverside Similar to past years, in 2018 a slightly higher proportion of opt-outs and non. CCI respondents (48%) reported they were in fair or poor health compared to CMC, of whom (43%) reported fair or poor health. Los Angeles Health Status and Disability of CMC Enrollees and Opt- Outs Overall Findings in Brief Orange 11
Orange * Personal care needs defined as: eating, bathing, dressing, or getting around inside the home. ** Routine needs defined as: everyday household chores, doing necessary business, shopping or getting around for other purposes San Mateo 28% of CMC enrollees using IHSS said that their CMC plan helped them enroll or advocate for more hours. Santa Clara Slightly more CMC enrollees and opt-outs with disabilities reported receiving IHSS (88% and 91%) in 2018 compared to non-CMC counties, where 84% of LTSS beneficiaries received IHSS. San Diego Of those who reported needing help, about 4 in 10 beneficiaries in all groups had unmet needs for personal or routine care. San Bernardino CMC enrollees report the lowest rates of needing help with personal care* (51%) compared to opt-outs (64%) and non-CMC beneficiaries (55%). Riverside In 2017 and 2018, LTSS beneficiaries in all three groups were asked about their needs for LTSS and use of In-Home Supportive Services (IHSS), California’s consumer directed personal assistance program. Los Angeles LTSS Needs and Use of In-Home Supportive Services Overall Findings in Brief 12
San Bernardino San Diego Santa Clara Large majorities of both enrollees and opt-outs are people of color, with Latinos comprising the largest segment of both groups, accounting for 47% of CMC enrollees and 41% of opt-outs. Less than 20% of CMC enrollees and opt-outs are white non-Hispanic, while 34% of duals in non-CCI counties were white non-Hispanic. Riverside Both CMC enrollees and opt-outs have very low levels of educational attainment, with 46% of CMC enrollees and 44% of opt-outs who did not graduate high school. Approximately one-fifth of CMC enrollees and optouts have a high school diploma. Los Angeles Characteristics of CMC Enrollees & Opt-outs Overall Findings in Brief Age varied across groups, with a larger percent (22%) of CMC enrollees under age 65, compared to only 20% of opt-outs. San Mateo While both groups are majority female, opt-outs have a higher distribution of females (63%). Orange Among all groups, about a quarter live alone. 13
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara Overall Findings Across the Four Survey Years San Mateo Orange 14
San Diego Santa Clara Furthermore, CMC enrollees’ confidence in these areas has progressively increased between 2015 and 2018; while confidence among opt-outs has remained steady. San Bernardino In 2018, CMC enrollees’ confidence in these areas was slightly higher than optouts. Riverside Very large majorities of CMC enrollees in 2018 continue to express confidence that they know how to manage their health conditions (82%), can get questions about their health needs answered (84%), and know who to call if they have a health need or question (89%). Los Angeles 1. Beneficiary Confidence Navigating Health Care Overall Findings San Mateo Orange 15
Overall Findings Table 1 Los Angeles Beneficiary Confidence Navigating Health Care (% very & somewhat confident) 2017 2016 (% very & somewhat confident) 2016 2015 2018 2017 2016 2015 84% 83% 81% 79% 83% 79% 81% 82% 84% 85% 86% 77% 85% 83% 84% 83% 87% 84% 78% 89% 88% 85% 81% Orange (% yes) 2017 83% 82% 89% 78% San Mateo Know who to call if you have a health need or question 2018 80% 79% 82% 80% Santa Clara Can get questions about your health needs answered 82% 84% 80% 79% San Diego 2015 Non-CMC counties San Bernardino Know how to manage your health conditions 2018 CMC opt-outs Riverside CMC enrollees 16
§ the way different providers work together, and Orange In 2018, those who opted out were more satisfied than CMC enrollees with their choice of hospital. San Mateo § their ability to call a provider regardless of the time of day. Santa Clara § the information they got from their health plan explaining benefits, San Diego In 2018, CMC enrollees were more satisfied than opt-outs in the areas of: San Bernardino Satisfaction levels expressed by CMC enrollees have steadily improved over time in each of the 7 areas. Riverside Large majorities of CMC enrollees in 2018 – ranging from 77% to 89% – report being satisfied with the health services they are receiving in each of 7 areas. Los Angeles 2. Satisfaction with Health Care Services Overall Findings 17
Overall Findings Table 2 Non-CMC counties 89% 86% 89% 88% 82% 87% 83% 85% 83% 82% 75% 79% 74% 82% 77% 78% 69% Your choice of doctors (% very or somewhat satisfied) 2018 2017 2016 2015 86% 83% 78% 87% 84% 87% 85% 83% 86% 84% 80% Your choice of hospitals (% very or somewhat satisfied) 2018 2017 2016 2015 79% 79% 78% 83% 79% 83% 84% 80% 81% 82% 79% (% very or somewhat satisfied) Orange 2018 2017 2016 2015 San Mateo Information health plan gives explaining your benefits Santa Clara 2018 2017 2016 2015 San Diego Amount of time doctor/other staff spend with you (% very or somewhat satisfied) San Bernardino 89% 88% 86% 84% CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) 18
Overall Findings Table 2 2017 2016 2015 83% 80% 84% 80% 77% 78% 80% 70% 2018 77% 78% 75% 67% 76% N/A 76% 74% 73% N/A 2017 2016 2015 N/A Orange 82% 78% 81% 78% San Mateo 79% 78% 77% 74% Santa Clara 2018 How long you have to wait 2017 to see a doctor when you 2016 need an appointment (% very and somewhat satisfied) 2015 Your ability to call a health provider regardless of the time of day (% very and somewhat satisfied) 82% 80% 85% 81% San Diego 84% 83% 82% 78% 2018 Non-CMC counties San Bernardino The way different providers work together (% very and somewhat satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Note: N/A indicates the question was not asked in Year 1. 19
• denied treatment or referral for a service recommended by a doctor (17% in 2015 down to 13% in 2018) • having a misunderstanding about health care coverage (21% in 2015 down to 14% in 2018) Opt-outs were slightly less likely than CMC enrollees to report that they had a treatment or referral denied, and the doctor they were seeing was not available their plan. Orange CMC enrollees were slightly less likely than opt-outs to have trouble in the areas of transportation problems keeping them from getting needed health care and having a misunderstanding about health care coverage. San Mateo a doctor they had been seeing was no longer available through their plan (23% in 2015 down to 16% in 2018) Santa Clara • San Diego In 3 areas, CMC enrollees in 2018 had lower rates of reported problems than they had in previous years, including: San Bernardino The two most commonly reported problems encountered by CMC enrollees were that a doctor they had been seeing was no longer available through their plan (16%), and that they had a misunderstanding about their health care services or coverage (14%). Riverside In 2018, no single problem was reported by more than 16% of CMC enrollees. Los Angeles 3. Specific Problems with Health Care Services Overall Findings 20
Overall Findings Table 3 2018 2017 2016 2015 2018 2017 2015 17% 21% 19% 24% 19% 20% 23% 20% 13% 14% 15% 17% 10% 13% 14% 16% 13% 16% 19% Orange 2016 14% 19% 17% 21% San Mateo Was denied a treatment or referral for another service recommended by a doctor 17% 18% 17% 14% Santa Clara Had a misunderstanding about your health care services or coverage 2018 13% 18% 16% 20% 16% 18% 19% 23% San Diego 2015 Non-CMC counties San Bernardino A doctor you were seeing is not available through your plan CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services (1) 21
Overall Findings Table 3 2018 2017 2016 2015 10% 10% 12% 10% 7% 11% 13% 16% 15% 13% 17% 14% 13% 10% 13% 15% 11% 9% 12% 18% 9% 21% Orange Health provider did not speak your language and no interpreter was available (among non. English speakers) 2015 San Mateo 2018 2016 17% 16% 17% 15% Santa Clara Had trouble communicating with a health provider because of a speech, hearing or other disability 2017 15% 15% 16% 12% 13% 12% 14% San Diego 2018 Non-CMC counties San Bernardino Transportation problems kept you from getting needed health care CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services (2) 22
San Diego Santa Clara San Mateo CMC enrollees that report having been with their personal doctor for 2 or more years increased from 69% in 2015 to 83% in 2018. San Bernardino Only 14% of opt-out beneficiaries and 16% of CMC enrollees reported that they had been seeing their personal doctor for a short period (1 year or less), lower than non-CCI beneficiaries (22%). Riverside The proportions of both CMC enrollees and opt-outs that report they have been seeing their personal doctor* for 1 year or less has declined significantly over the years. 2017 was the first year that the percent of CMC enrollees having a doctor for 1 year or less has been lower than non-CCI counties, and this trend continued in 2018. Los Angeles 4. Length of Time Beneficiaries Have Been Going to their Personal Doctor Overall Findings Orange * A “personal doctor” was defined in the survey as “the doctor who knows you best and can refer you to other doctors when you need to see a specialist. ” 23
Overall Findings Non-CMC counties 14% 12% 14% 20% 22% 24% 19% 12% 28% 29% 33% 34% 44% 35% 34% San Diego 6 -10 years 2018 2017 2016 2015 23% 22% 23% 21% 27% 27% 24% 20% 18% 25% 35% More than 10 years 2018 2017 2016 2015 23% 18% 15% 13% 31% 32% 19% 22% 24% 15% 20% 19% 37% 41% 39% 35% Note: Asked only of beneficiaries who report having a personal doctor. Differences between 100% and the sum of the percentages for each group equal proportion who could not give an estimate. Orange 2 -5 years 2018 2017 2016 2015 San Mateo 1 year or less 2018 2017 2016 2015 Santa Clara CMC opt-outs San Bernardino 16% 19% 23% 30% Riverside CMC enrollees Los Angeles Length of Time Beneficiaries Have Been Going to the Doctor They Consider their Personal Doctor 24
San Diego Santa Clara Over half (57%) of CMC enrollees and (63%) opt-outs with single care managers in 2018 said that having such a manager has improved their care “a lot. ” San Bernardino The proportion of CMC enrollees and opt-outs who reported having a single care manager declined, from about a third in 2016 to about a quarter in 2018. Riverside Only a quarter of CMC enrollees in 2018 reported that they had a single care manager, * such as a nurse or other helper from their health plan, who serves as their main point of contact and arranges all aspects of their care. Los Angeles 5. Beneficiaries’ Experiences with Single Care Managers Overall Findings San Mateo Orange * Single care manager described as “the person who serves as your main point of contact and arranges all aspects of your care. ” 25
Overall Findings Riverside CMC Non-CMC opt-outs counties 2016 2017 2018 If yes, has improved care… 63 A little 20 64 57 65 71 63 68 70 71 18 21 19 14 19 17 11 17 7 9 11 7 6 8 8 12 1 Not reported 9 9 11 9 9 10 7 7 12 San Mateo Not at all Santa Clara A lot San Diego Has a single care manager* 33% 32% 24% 33% 27% 20% 36% 31% 20% San Bernardino CMC enrollees Los Angeles Beneficiaries Who Report Having a Single Care Manager and Its Perceived Impact on Quality of Care Orange * Single care manager described as “the person who serves as your main point of contact and arranges all aspects of your care. ” Note: Question not asked in 2015. 26
San Bernardino San Diego Santa Clara Nearly two-thirds (65%) of CMC enrollees with a personal care plan said that having a personal care plan improved their care “a lot. ” This is similar to opt outs (68%), but significantly higher than non-CMC duals, of whom 48% said the personal care plan improved their care “a lot. ” Riverside A quarter of CMC enrollees reported in 2018 that they have a personal care plan* that takes into account their health goals, needs and preferences. This is significantly lower than the 33% reported in 2016. This proportion decreased significantly in all three groups. Los Angeles 6. Beneficiaries’ Experiences with a Personal Care Plan Overall Findings San Mateo Orange * Personal care plan described as a plan designed to take into account your health goals, needs and preferences. 27
Overall Findings Riverside CMC Non-CMC opt-outs counties 2016 2017 2018 41% 36% 24% If yes, it has improved care… 64 68 65 70 62 68 63 62 48 22 18 23 18 16 19 24 22 31 Not at all 7 6 5 6 9 5 7 7 6 Not reported 7 8 7 6 13 8 6 3 15 San Mateo A little Santa Clara A lot San Diego Has a personal care plan* 33% 32% 26% 36% 27% 23% San Bernardino CMC enrollees Los Angeles Beneficiaries Who Report Having a Personal Care Plan and Its Perceived Impact on the Quality of Their Care Orange * Personal care plan described as a plan designed to take into account your health goals, needs and preferences. Note: Question not asked in 2015. 28
Santa Clara San Mateo Orange § About 78% of enrollees and 81% opt-outs are age 65 or older. Among those over 65, a greater proportion of opt-outs are 75 and older (39%) compared to CMC enrollees (49%). San Diego § A large majority of both CMC enrollees and opt-outs are people of color. For example, among enrollees 47% are Latino, 13% are Asian American and 10% are African American, while just 19% are white non-Hispanic. The distributions are similar among opt-outs with 41% Latino, 16% Asian American and 13% African American. Only 18% of opt-outs are white non. Hispanic. San Bernardino § Majorities of both enrollees and opt-outs are women, although women constitute a slightly larger proportion of opt-outs (63%) than CMC enrollees (57%). Riverside The following are the demographic characteristics of each group combined across all 4 years of the survey: Los Angeles 7. Demographic Characteristics of Enrollees and Opt-outs Across the Seven CMC Counties (1) Overall Findings 29
Overall Findings 43% Female 37% 57% 22% 65 -74 20% 38% 49% 19% Latino 18% 47% 41% 10% 13% Asian American 13% 16% Other/not reported 11% Note: Percentages shown are the combined totals for enrollees and opt-outs in CMC counties across all survey waves. Orange African American San Mateo Race/ethnicity White non-Hispanic 32% Santa Clara 39% 75 or older San Diego Age Under 65 63% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of Enrollees and Opt-outs in CMC Counties (1) 30
San Bernardino San Diego § About six in ten CMC enrollees (60%) and opt-outs (59%) report receiving Supplemental Security Income/Payment or other support from the federal government. Riverside § Among both CMC enrollees and opt-outs, almost half have not graduated from high school, while another one in five have no more than a high school degree. Very few – 9% of enrollees and 10% of opt-outs – are college graduates. Los Angeles Demographic Characteristics of Enrollees and Opt-outs in CMC Counties (2) Overall Findings Santa Clara San Mateo Orange 31
Overall Findings Not a high school graduate 46% Some college/trade school 19% 14% 13% 10% 59% San Mateo 9% Santa Clara College graduate 20% San Diego High school graduate 44% San Bernardino Education CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of Enrollees and Opt-outs in CMC Counties (2) Receive Supplemental Security Income/Payment Yes No 60% 36% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 32
San Diego § Among opt-outs 44% are LTSS beneficiaries who require assistance for common daily activities. This compares to 31% among CMC enrollees. San Bernardino § Slightly more opt-outs (48%) rated their own health as fair or poor, compared to 43% of CMC enrollees. Riverside Opt-outs report more disability, and more acute care utilization than those enrolled in CMC. Los Angeles 8. Health-status and Disability of CMC Enrollees and Opt-outs Overall Findings § More opt-outs (53%) than enrollees (43%) also report using specialized equipment, such as a cane, wheelchair, scooter or special bed. Santa Clara § A slightly larger proportion of opt-outs (28%) than enrollees (20%) say they have been an overnight patient in a hospital in the past 12 months. San Mateo Orange 33
Overall Findings CMC opt-outs 43% 31% 44% San Mateo 20% 28% Orange Overnight patient in a hospital past 12 months 53% Santa Clara Require assistance for common daily activities* 43% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 48% San Bernardino In fair or poor health Riverside CMC enrollees Los Angeles Comparing Health and Disability Status * Common daily activities are defined as bathing, dressing, help with prepared meals, help doing housework, or grocery shopping. 34
Santa Clara Similar percentages of all duals with disabilities reported receiving IHSS (CMC 88%; opt out 91%, and non-CCI 84%) in 2018. San Diego Of those who reported needing help, about 4 in 10 beneficiaries in all groups had unmet needs for personal or routine care. San Bernardino CMC enrollees have lower rates of reporting needing help with personal care* (51%) compared to opt-outs (64%) and non-CMC beneficiaries (55%). Riverside In 2017 and 2018, LTSS beneficiaries in all three groups were asked about their LTSS needs and use of In-Home Supportive Services (IHSS), California’s consumer directed personal assistance program. Los Angeles 9. Disability and Use of In-Home Supportive Services Overall Findings San Mateo Orange * Personal care needs defined as: eating, bathing, dressing, or getting around inside the home. ** Routine needs defined as: everyday household chores, doing necessary business, shopping or getting around for other purposes 35
Overall Findings Los Angeles LTSS Needs and Use of IHSS in 2018 Riverside 51% 64% 55% Needs help with routine needs 78% 83% 77% LTSS beneficiaries currently using IHSS* 88%# 91%# 84%# Average number IHSS hours/month 90 103 95 41% 39% Unmet need for personal or routine care 40% Orange • The question about IHSS was only asked if the beneficiary responded yes that they needed assistance with personal care and/or assistance with routine needs • # The percentages reflect the fraction of people who need help with personal or routine care who are using IHSS • San Mateo Needs help with personal care needs Santa Clara Non-CMC counties San Diego CMC opt-outs San Bernardino CMC enrollees 36
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara Los Angeles County: Aggregated Results from Years 1 -4 San Mateo Orange 37
Riverside San Bernardino San Diego Both CMC enrollees and opt-outs in Los Angeles County express similar high levels of confidence that they know how to manage their health conditions, can get questions about their health needs answered and know who to call if they have a health need or question. In each area, about eight in ten of both Los Angeles County enrollees and opt-outs express confidence in their ability to manage their condition. Los Angeles 1. Beneficiary Confidence Navigating Health Care in Los Angeles County Overall Los Angeles County Santa Clara San Mateo Orange 38
Overall Los Angeles County Table LA-1 CMC opt-outs 80% Can get questions about your health needs answered (% confident) 80% Santa Clara 85% 84% San Mateo Know who to call if you have a health need or question (% yes) San Diego 79% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in Los Angeles County Orange 39
San Bernardino San Diego Santa Clara § Amount of time doctor/other staff spend with you (87% among enrollees vs. 89% among opt-outs) Riverside Large majorities of CMC enrollees in Los Angeles County (between 77% and 87%) say they are satisfied with the health care services they are receiving in each of seven areas measured. CMC enrollees were more likely to be satisfied with their ability to call a health care provider regardless of the time of day (77% CMC vs. 73% opt-outs). Slightly more CMC opt-outs than enrollees are satisfied in five areas. These include: Los Angeles 2. Satisfaction with Health Care Services in Los Angeles County Overall Los Angeles County § Choice of doctors (83% vs. 87%) § Wait time to see a doctor when you need an appointment (78% vs. 81%). Orange § The way different providers work together (81% vs. 83%) San Mateo § Choice of hospitals (77% vs. 82%) 40
Overall Los Angeles County Table LA-2 87% 89% 78% Your choice of doctors (% satisfied) 83% 87% San Mateo 77% 82% Orange Your choice of hospitals (% satisfied) Santa Clara 81% San Diego Information health plan gives explaining your benefits (% satisfied) San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) 41
Overall Los Angeles County Table LA-2 78% 81% 77% 73% Santa Clara San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 83% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 81% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 42
San Diego Santa Clara San Mateo When comparing the incidence of problems reported by enrollees to those of opt-outs, enrollees are somewhat more likely to report that a doctor they were seeing is not available through their plan. San Bernardino The two most frequently mentioned problems, reported by less than 20% of both groups, are that a doctor they were seeing is not available through their plan or they had a misunderstanding about their health care services or coverage. Riverside Relatively small proportions of enrollees and opt-outs in Los Angeles County say they encountered any of six specific problems relating to their health services in the recent past. Los Angeles 3. Specific Problems with Health Care Services in Los Angeles County Overall Los Angeles County Orange 43
Overall Los Angeles County Table LA-3 17% 15% 20% San Diego Had a misunderstanding about your health care services or coverage 19% 13% 12% Transportation problems kept you from getting needed health care 12% 14% 11% Orange 9% San Mateo (among non- English speakers) 10% Santa Clara Was denied a treatment or referral for another service recommended by a doctor Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available San Bernardino A doctor you were seeing is not available through your plan CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in Los Angeles County 44
San Mateo Orange Greater than six in ten of CMC enrollees (62%) and opt-outs (63%) in the county say they receive Supplemental Security Income/Payment from the federal government. Santa Clara A large percentage of both CMC enrollees (49%) and opt-outs (45%) in Los Angeles County have not graduated from high school. Very small proportions are college graduates – 9% among enrollees and 13% among opt-outs. San Diego Less than 25% of both enrollees and opt-outs in Los Angeles County are under age 65, while over three-quarters are age 65 or older. San Bernardino Women comprise a somewhat larger share of the opt-out population in Los Angeles County (62%) than they do of CMC enrollees (55%). Riverside Over half of CMC enrollees in Los Angeles County are Latino (55%), a larger proportion than is found in the opt-out population (46%). Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in Los Angeles County Overall Los Angeles County 45
Overall Los Angeles County Table LA-4 45% Female 55% 25% 65 -74 36% 33% 42% Latino 17% 55% African American 15% 46% San Mateo 14% Santa Clara Race/ethnicity White non-Hispanic 23% 42% 75 or older 62% San Diego Age Under 65 38% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) 15% 8% 13% Other/not reported 7% 8% Orange Asian American 46
Overall Los Angeles County Table LA-4 CMC opt-outs Not a high school graduate Some college/trade school 18% 17% 29% 63% San Mateo 62% Santa Clara 13% 9% Receive Supplemental Security Income/Payment Yes No 18% 20% San Diego High school graduate College graduate 45% 49% San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 27% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 47
San Diego Santa Clara San Mateo However, a slightly larger proportion of opt-outs (51%) than enrollees (44%) does report using specialized equipment, such as a cane, wheelchair, scooter or special bed or report requiring assistance for common daily activities (46% vs. 36%). San Bernardino This is noteworthy, especially since differences observed in the self-reported health status of the two populations in the county report being in fair or poor physical health at similar percentages: CMC enrollees (48%) and opt-outs (51%). Riverside A somewhat smaller proportion of CMC enrollees (23%) than beneficiaries who opted out in Los Angeles County (30%) say they were an overnight patient in the hospital in the past year. Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in Los Angeles County Overall Los Angeles County Orange 48
Overall Los Angeles County 48% 44% Santa Clara Require assistance for common daily activities 36% 46% San Mateo 23% 30% Orange Overnight patient in a hospital past 12 months 51% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 51% San Bernardino In fair or poor health CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs 49
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara Riverside County: Aggregated Results from Years 1 -4 San Mateo Orange 50
Riverside San Bernardino Both CMC enrollees and opt-outs in Riverside County express similar high levels of confidence that they know how to manage their health conditions, can get questions about their health needs answered and know who to call of they have a health need or question. In each area, greater than eight in ten of both Riverside County enrollees and opt-outs express confidence. Los Angeles 1. Beneficiary Confidence Navigating Health Care in Riverside County Overall Riverside County San Diego Santa Clara San Mateo Orange 51
Overall Riverside County Table RIV-1 CMC opt-outs 82% Can get questions about your health needs answered (% confident) 82% 83% Santa Clara 87% 86% San Mateo Know who to call if you have a health need or question (% yes) San Diego 81% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in Riverside County Orange 52
Riverside San Bernardino Large majorities of CMC enrollees in Riverside County (between 73% and 84%) say they are satisfied with the health care services they are receiving in seven areas measured. However, slightly larger proportions of CMC opt-outs than enrollees in the county report being satisfied in only one area, the choice of hospitals (79% among enrollees vs. 84% among enrollees). Los Angeles 2. Satisfaction with Health Care Services in Riverside County Overall Riverside County San Diego Santa Clara San Mateo Orange 53
Overall Riverside County Table RIV-2 CMC opt-outs 88% Information health plan gives explaining your benefits (% satisfied) 84% 83% San Diego 85% San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) Santa Clara 81% 83% Your choice of hospitals (% satisfied) 79% 84% San Mateo Your choice of doctors (% satisfied) Orange 54
Overall Riverside County Table RIV-2 75% Santa Clara 78% San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 74% 81% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 82% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 55
Riverside San Bernardino Relatively small proportions of enrollees and opt-outs in Riverside County say they encountered any of six specific problems relating to their health services in the recent past. The two most commonly reported problems are that a doctor they were seeing is not available through their plan (22%) or that they had a misunderstanding about their health care services or coverage (19%). Los Angeles 3. Specific Problems with Health Care Services in Riverside County Overall Riverside County San Diego Santa Clara San Mateo Orange 56
Overall Riverside County Table RIV-3 Was denied a treatment or referral for another service recommended by a doctor 13% 10% 12% 18% 14% 12% 13% Orange (among non- English speakers) 16% San Mateo Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available 21% Santa Clara Transportation problems kept you from getting needed health care 19% 23% San Diego Had a misunderstanding about your health care services or coverage 22% San Bernardino A doctor you were seeing is not available through your plan CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in Riverside County 57
San Mateo Orange Nearly two in three of CMC enrollees (64%) and opt-outs in the county (62%) say they receive Supplemental Security Income/Payment from the federal government. Santa Clara Almost half of CMC enrollees (45%) in Riverside County have not graduated from high school, and this increases to 48% among opt-outs. Very small proportions of beneficiaries in the county are college graduates – 9% among enrollees and 7% among opt-outs. San Diego A little less than four in ten CMC enrollees in Riverside County are under age 65 (39%), 41% are age 65 -74 and 20% are age 75 or older. This differs slightly from the age distribution of opt-outs, of whom 32% are under age 65, 40% are age 65 -74 and 28% are age 75 or older. San Bernardino Women comprise a somewhat larger share of the opt-out population (61%) than they do of the county’s CMC enrollees (54%). Riverside Slightly under half of CMC enrollees in Riverside County are Latino (49%), while among opt-outs, a 52% majority are Latino. Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in Riverside County Overall Riverside County 58
Overall Riverside County Table RIV-4 46% Female 54% 39% 65 -74 41% 20% African American Other/not reported 28% 49% 9% 3% 7% 52% 8% 4% 7% Orange Asian American 28% 32% Latino 40% San Mateo Race/ethnicity White non-Hispanic 32% Santa Clara 75 or older 61% San Diego Age Under 65 39% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) 59
Overall Riverside County Table RIV-4 CMC opt-outs Not a high school graduate Some college/trade school 20% 19% 27% 62% San Mateo 64% Santa Clara 7% 9% Receive Supplemental Security Income/Payment Yes No 22% 23% San Diego High school graduate College graduate 48% 45% San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 29% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 60
San Diego Santa Clara Self-reported hospitalization of enrollees and opt-outs in the county have similar proportions, with about one in four enrollees (24%) and opt-outs (28%) reporting this. San Bernardino More than half of both enrollees (51%) and opt-outs (55%) also report using specialized equipment, such as a cane, wheelchair, scooter or special bed, and slightly less than half (40% among enrollees and 46% among opt-outs) require assistance in performing common daily activities. Riverside Around the same proportion of CMC enrollees (54%) report being in fair or poor physical health compared with opt-outs in the county (56%). Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in Riverside County Overall Riverside County San Mateo Orange 61
Overall Riverside County Table RIV-5 CMC opt-outs 54% 51% Santa Clara Require assistance for common daily activities 40% 46% San Mateo 24% 28% Orange Overnight patient in a hospital past 12 months 55% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 56% San Bernardino In fair or poor health Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs 62
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara San Bernardino County: Aggregated Results from Years 1 -4 San Mateo Orange 63
Riverside San Bernardino San Diego When asked whether they are confident that they know how to manage their health conditions, 83% of enrollees and 82% of opt-outs say they are. While 81% of enrollees say they are confident that they can get their questions about their health needs answered, a slightly larger proportion of opt-outs (84%) report this. Similar large majorities of enrollees (85%) and opt-outs (84%) also say they know who to call if they have a health need or question. Los Angeles 1. Beneficiary Confidence Navigating Health Care in San Bernardino County Overall San Bernardino County Santa Clara San Mateo Orange 64
Overall San Bernardino County Table SB-1 CMC opt-outs 82% Can get questions about your health needs answered (% confident) 81% 84% Santa Clara 85% 84% San Mateo Know who to call if you have a health need or question (% yes) San Diego 83% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in San Bernardino County Orange 65
Santa Clara § Choice of hospitals (79% vs. 83%) San Diego § Choice of doctors (80% vs. 86%) San Bernardino § Amount of time their doctor or other staff spend with them (83% among enrollees vs. 88% among opt-outs) Riverside While large majorities of CMC enrollees in San Bernardino County (between 70% and 83%) are satisfied with the health care services they are receiving in each of the seven areas measured, slightly more CMC opt-outs than enrollees report being satisfied in three areas. These include: Los Angeles 2. Satisfaction with Health Care Services in San Bernardino County Overall San Bernardino County San Mateo Orange 66
Overall San Bernardino County Table SB-2 83% 88% 83% Your choice of doctors (% satisfied) 80% 86% Your choice of hospitals (% satisfied) 79% 83% Santa Clara 79% San Diego Information health plan gives explaining your benefits (% satisfied) San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) San Mateo Orange 67
Overall San Bernardino County Table SB-2 75% Santa Clara 78% 77% San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 70% 83% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 80% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 68
Riverside San Bernardino San Diego Between 12% and 20% of CMC enrollees or opt-outs in San Bernadino County say they encountered any of six specific problems relating to their health services in the recent past. The two most commonly reported problems are that a doctor they were seeing was not available through their plan (20%) or that they had a misunderstanding about their health care services or coverage (20%). Los Angeles 3. Specific Problems with Health Care Services in San Bernardino County Overall San Bernardino County Santa Clara San Mateo Orange 69
Overall San Bernardino County Table SB-3 CMC opt-outs 16% Had a misunderstanding about your health care services or coverage 20% 17% Was denied a treatment or referral for another service recommended by a doctor 12% 14% 13% 12% Orange (among non- English speakers) 14% 15% San Mateo Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available 18% Santa Clara Transportation problems kept you from getting needed health care San Diego 20% San Bernardino A doctor you were seeing is not available through your plan Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in San Bernardino County 70
San Mateo Orange About two in three of both CMC enrollees (64%) and opt-outs (66%) say they receive Supplemental Security Income/Payment from the federal government. Santa Clara Slightly more than four in ten CMC enrollees (42%) and opt-outs (40%) have not graduated from high school. Less then 10% of each group are college graduates. San Diego A relatively large proportion of enrollees and opt-outs are under age 65, comprising 43% of the county's enrollee population and 39% of all opt-outs. By contrast, only about a quarter of enrollees (19%) or opt-outs (23%) in the county are age 75 or older among enrollees. San Bernardino Women comprise a somewhat larger share of the opt-out group (60%) than they do among CMC enrollees (56%). Riverside Almost half of CMC enrollees in San Bernardino County are Latino (45%), while among opt-outs, 42% are Latino. Another 14% of enrollees are African American, while among opt-outs 13% are African American. About 3% in both groups are Asian American. Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in San Bernardino County Overall San Bernardino County 71
Overall San Bernardino County Table SB-4 CMC opt-outs Male 40% 44% 56% Under 65 43% 65 -74 38% 39% 38% 23% 19% Santa Clara 75 or older 60% San Diego Female Age San Bernardino Gender Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) Race/ethnicity Latino 45% African American Other/not reported 14% 3% 10% 42% 13% 3% 9% Orange Asian American 34% 29% San Mateo White non-Hispanic 72
Overall San Bernardino County Table SB-4 CMC opt-outs Not a high school graduate Some college/trade school 20% 21% 26% 66% San Mateo 64% Santa Clara 9% 8% Receive Supplemental Security Income/Payment Yes No 27% 26% San Diego High school graduate College graduate 40% 42% San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 26% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 73
Santa Clara San Mateo However, a slightly larger proportion of opt-outs (54%) than enrollees (50%) say they use specialized equipment, such as a cane, wheelchair, scooter or special bed. San Diego Similar proportions of enrollees (24%) and opt-outs (26%) in the county – about one in four – say they have been an overnight patient in a hospital in the past year. San Bernardino Slightly less than half of enrollees (42%) and opt-outs (45%) say they require assistance for common daily activities. Riverside About half of CMC enrollees (53%) and opt-outs (54%) in San Bernardino County say they are in fair or poor physical health. Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in San Bernardino County Overall San Bernardino County Orange 74
Overall San Bernardino County Table SB-5 53% 50% Santa Clara Require assistance for common daily activities 42% 45% San Mateo 24% 26% Orange Overnight patient in a hospital past 12 months 54% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 54% San Bernardino In fair or poor health CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs 75
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara San Diego County: Aggregated Results from Years 1 -4 San Mateo Orange 76
Riverside San Bernardino Both CMC enrollees and opt-outs in San Diego County express similar high levels of confidence that they know how to manage their health conditions, can get questions about their health needs answered, and know who to call of they have a health need or question. About eight in ten CMC enrollees and optouts express confidence in each area measured. Los Angeles 1. Beneficiary Confidence Navigating Health Care in San Diego County Overall San Diego County San Diego Santa Clara San Mateo Orange 77
Overall San Diego County Table SD-1 CMC opt-outs 82% Can get questions about your health needs answered (% confident) 82% 84% Santa Clara 85% 84% San Mateo Know who to call if you have a health need or question (% yes) San Diego 82% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in San Diego County Orange 78
San Bernardino San Diego Santa Clara § Amount of time their doctor or other staff spend with them (86% among enrollees vs. 89% among opt-outs) Riverside Large majorities of CMC enrollees in San Diego County (between 75% and 86%) say they are satisfied with the health care services they are receiving in each of seven areas measured. CMC enrollees are significantly more satisfied with the information the health plan gives them about their benefits (81% CMC vs. 76% opt-outs). Slightly fewer enrollees than opt-outs say they are satisfied in four areas. These include: Los Angeles 2. Satisfaction with Health Care Services in San Diego County Overall San Diego County § Choice of doctors (81% vs. 85%) Orange § Wait time to see a doctor when you need an appointment (76% vs. 82%) San Mateo § Choice of hospitals (82% vs. 86%) 79
Overall San Diego County Table SD-2 86% 89% 76% Your choice of doctors (% satisfied) 81% 85% Your choice of hospitals (% satisfied) 82% 86% Santa Clara 81% San Diego Information health plan gives explaining your benefits (% satisfied) San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) San Mateo Orange 80
Overall San Diego County Table SD-2 76% 82% 75% 76% Santa Clara San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 82% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 82% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 81
Riverside San Bernardino San Diego Relatively small proportions (between 9% and 22%) of CMC enrollees say they encountered any of six specific problems relating to their health services in the recent past. Most frequently mentioned are that a doctor they were seeing is not available through their plan (22%) or they had a misunderstanding about their health care services or coverage (20%). In each case, about one in five enrollees and opt-outs report experiencing this problem. Los Angeles 3. Specific Problems with Health Care Services in San Diego County Overall San Diego County Santa Clara San Mateo Orange 82
Overall San Diego County Table SD-3 22% Had a misunderstanding about your health care services or coverage 20% 14% 9% 13% 7% Orange 14% 16% San Mateo (among non- English speakers) 17% Santa Clara Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available 23% San Diego Was denied a treatment or referral for another service recommended by a doctor Transportation problems kept you from getting needed health care 21% San Bernardino A doctor you were seeing is not available through your plan CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in San Diego County 83
Greater than six in ten of CMC enrollees (64%) and opt-outs (62%) say they receive Supplemental Security Income/Payment from the federal government. Santa Clara Over one in three CMC enrollees (39%) and opt-outs (35%) have not graduated from high school, while relatively few are college graduates. San Diego 36% of CMC enrollees and 30% of opt-outs are under age 65. San Bernardino A majority of both enrollees (56%) and opt-outs (61%) are women. Riverside The largest minority group is Latinos (43% among enrollee and 38% opt-out), with each group accounting for around four in ten of the total. Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in San Diego County Overall San Diego County San Mateo Orange 84
Overall San Diego County Table SD-4 44% Female 56% 36% 65 -74 41% 23% Other/not reported 34% 43% 9% 7% 10% 38% 10% 7% 11% Orange Asian American 31% Latino 39% San Mateo Race/ethnicity White non-Hispanic 30% Santa Clara 75 or older 61% San Diego Age Under 65 African American 39% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) 85
Overall San Diego County Table SD-4 CMC opt-outs Not a high school graduate Some college/trade school 41% 42% 28% 62% San Mateo 64% Santa Clara 14% 11% Receive Supplemental Security Income/Payment Yes No 20% 23% San Diego High school graduate College graduate 35% 39% San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 31% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 86
San Diego Santa Clara However, a slightly larger proportion of opt-outs (51%) than enrollees (43%) say they use specialized equipment, such as a cane, wheelchair, scooter or special bed, and opt-outs (41%) are also more likely than enrollees (30%) to report requiring assistance for common daily activities. San Bernardino About half of CMC enrollees (46%) and opt-outs (49%) report being in fair or poor physical health. Riverside A smaller proportion of CMC enrollees (24%) than opt-outs (30%) in San Diego County report having been an overnight patient in a hospital in the past year. Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in San Diego County Overall San Diego County San Mateo Orange 87
Overall San Diego County Table SD-5 46% 30% 41% San Mateo 24% 30% Orange Overnight patient in a hospital past 12 months 51% Santa Clara Require assistance for common daily activities 43% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 49% San Bernardino In fair or poor health CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs 88
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara County: Aggregated Results from Years 1 -4 San Mateo Orange 89
San Bernardino San Diego Equal percentages (78%) in both groups reported they know who to call if they have a health need or question. Riverside Large majorities of CMC enrollees and opt-outs in Santa Clara County express confidence that they know how to manage their health conditions (81% CMC enrollees and 84% opt outs) and can get questions about their health needs answered (80% CMC enrollees and 83% opt outs). Los Angeles 1. Beneficiary Confidence Navigating Health Care in Santa Clara County Overall Santa Clara County Santa Clara San Mateo Orange 90
Overall Santa Clara County Table SC-1 CMC opt-outs Can get questions about your health needs answered (% confident) 80% 83% Know who to call if you have a health need or question (% yes) 78% Santa Clara 84% San Diego 81% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in Santa Clara County San Mateo Orange 91
Riverside San Bernardino San Diego Large majorities of CMC enrollees in Santa Clara County (between 71% and 84%) say they are satisfied with the health care services they are receiving in each of seven areas measured. While in the past, there were several areas where opt-outs had significantly higher satisfaction than enrollees, by 2018 there were no significant differences between the groups on any measure of satisfaction. Los Angeles 2. Satisfaction with Health Care Services in Santa Clara County Overall Santa Clara County Santa Clara San Mateo Orange 92
Overall Santa Clara County Table SC-2 74% 84% 74% San Diego Information health plan gives explaining your benefits (% satisfied) 84% San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) Santa Clara 79% 82% Your choice of hospitals (% satisfied) 79% 81% San Mateo Your choice of doctors (% satisfied) Orange 93
Overall Santa Clara County Table SC-2 76% Santa Clara 71% 70% San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 74% 79% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 79% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 94
Riverside San Bernardino Relatively small proportions of enrollees and opt-outs in Santa Clara County say they encountered any of six specific problems relating to their health services in the recent past. About one in five CMC enrollees say that a doctor they were seeing is not available through their plan or that they had a misunderstanding about their health care services or coverage. Los Angeles 3. Specific Problems with Health Care Services in Santa Clara County Overall Santa Clara County San Diego Santa Clara San Mateo Orange 95
Overall Santa Clara County Table SC-3 CMC opt-outs 18% Had a misunderstanding about your health care services or coverage 21% 25% Was denied a treatment or referral for another service recommended by a doctor 13% 16% 20% 17% 20% Orange (among non- English speakers) 16% San Mateo Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available 18% Santa Clara Transportation problems kept you from getting needed health care San Diego 20% San Bernardino A doctor you were seeing is not available through your plan Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in Santa Clara County 96
Orange § About 60% of CMC enrollees and 66% of opt-outs say they receive Supplemental Security Income/Payment from the federal government. San Mateo § About one in four of each group are under age 65 (28% CMC, 24% opt outs), while 37% of enrollees and 46% of opt-outs are age 75 or older. Santa Clara § A majority of both enrollees (57%) and opt-outs (60%) are women. San Diego The enrollee and opt-out populations in Santa Clara County are similar on most of their other demographic characteristics. For example: San Bernardino A large proportion of CMC enrollees (40%) and 32% of opt-outs have not graduated from high school. At the other end of the scale, college graduates account for 18% of the county’s enrollees, and 22% of its opt-outs. Riverside Latinos account for the largest proportion of Santa Clara county’s enrollees (42%) and opt-outs (36%). A relatively large proportion of the CMC enrollees are Asian American (23%) and opt-outs (30%). Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in Santa Clara County Overall Santa Clara County 97
Overall Santa Clara County Table SC-4 43% Female 57% 28% 65 -74 Latino 21% 42% 3% 5% 23% 7% 36% 30% 7% Orange Asian American 46% San Mateo 25% 29% Santa Clara 37% Race/ethnicity White non-Hispanic Other/not reported 24% 35% 75 or older 60% San Diego Age Under 65 African American 40% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) 98
Overall Santa Clara County Table SC-4 CMC opt-outs Not a high school graduate 22% 21% 18% 20% College graduate 18% 22% No 60% 31% 66% San Mateo Receive Supplemental Security Income/Payment Yes Santa Clara Some college/trade school San Diego High school graduate 32% 40% San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 25% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 99
San Diego Santa Clara Just under a quarter of both CMC enrollees and opt-outs reported being an overnight patient in a hospital in the past year. San Bernardino Larger proportion of opt-outs (49%) than enrollees (42%) say they use specialized equipment, such as a cane, wheelchair, scooter or special bed, and opt-outs (45%) are also more likely than enrollees (35%) to report requiring assistance for common daily activities. Riverside Slightly fewer enrollees (45%) than opt-outs (55%) in Santa Clara County report being in fair or poor physical health. Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in San Diego County Overall Santa Clara County San Mateo Orange 100
Overall Santa Clara County Table SC-5 45% 42% Santa Clara Require assistance for common daily activities 35% 45% San Mateo 23% 24% Orange Overnight patient in a hospital past 12 months 49% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 55% San Bernardino In fair or poor health CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs 101
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara San Mateo County: Aggregated Results from Years 1 -4 San Mateo Orange 102
Riverside San Bernardino Both CMC enrollees and opt-outs in San Mateo County express similar high levels of confidence that they know how to manage their health conditions (82% and 89% respectively) and can get questions about their health needs answered (83% and 90%). Greater than eight in ten say they are confident in each of the three areas measured. Los Angeles 1. Beneficiary Confidence Navigating Health Care in San Mateo County Overall San Mateo County San Diego Santa Clara San Mateo Orange 103
Overall San Mateo County Table SM-1 CMC opt-outs 89% Can get questions about your health needs answered (% confident) 83% 90% Santa Clara 86% 89% San Mateo Know who to call if you have a health need or question (% yes) San Diego 82% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in San Mateo County Orange 104
Riverside San Bernardino While large majorities of CMC enrollees in San Mateo County (between 76% and 90%) say they are satisfied with the services they are receiving in each of seven areas, on each measure 100% of CMC opt-outs report being satisfied; however, San Mateo County has a very small sample size for opt-outs. Los Angeles 2. Satisfaction with Health Care Services in San Mateo County Overall San Mateo County San Diego Santa Clara San Mateo Orange 105
Overall San Mateo County Table SM-2 82% 100% San Diego Information health plan gives explaining your benefits (% satisfied) 90% San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) Santa Clara 86% 100% Your choice of hospitals (% satisfied) 84% 100% San Mateo Your choice of doctors (% satisfied) Orange 106
Overall San Mateo County Table SM-2 100% Santa Clara 76% 100% San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 82% 100% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 85% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 107
Riverside San Bernardino Fewer than one in five enrollees say they encountered any of six specific problems relating to their health services in the past year. Most commonly reported was having a misunderstanding about their health care services or coverage (17%). Los Angeles 3. Specific Problems with Health Care Services in San Mateo County Overall San Mateo County San Diego Santa Clara San Mateo Orange 108
Overall San Mateo County Table SM-3 17% 11% 10% San Diego Had a misunderstanding about your health care services or coverage 13% 10% Transportation problems kept you from getting needed health care 13% 11% 12% 0% 0% Orange (among non- English speakers) 15% San Mateo 13% Santa Clara Was denied a treatment or referral for another service recommended by a doctor Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available San Bernardino A doctor you were seeing is not available through your plan CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in San Mateo County 109
San Mateo Orange Majorities of both enrollees (56%) and opt-outs (60%) say they are receiving Supplemental Security Income/Payment from the federal government. Santa Clara While over half of opt outs (56%) did not graduate high school, only a third of CMC enrollees did not graduate high school. San Diego About one in five of enrollees (22%) and opt-outs (20%) in the county are under age 65, and about 40% are age 75 or older. San Bernardino A majority of both enrollees (62%) and opt-outs (67%) are women. Riverside White non-Hispanics account for a larger share of the County's CMC enrollees (25%) than are found among its opt-outs (10%). By contrast, Latinos comprise a far larger share of the county's opt-outs (60%) than they do of its enrollees (36%). About a quarter of the CMC enrollees (25%) and 20% of opt-outs in the county are Asian American. Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in San Mateo County Overall San Mateo County 110
Overall San Mateo County Table SM-4 38% Female 62% 22% 65 -74 20% 34% 43% Latino 36% 6% Other/not reported 60% 10% 25% 8% 10% 20% 0% Orange Asian American 40% San Mateo 25% 40% Santa Clara 75 or older Race/ethnicity White non-Hispanic 67% San Diego Age Under 65 African American 33% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) 111
Overall San Mateo County Table SM-4 CMC opt-outs Not a high school graduate 56% 33% 22% Some college/trade school 21% 11% College graduate 22% 11% No 56% 34% 60% San Mateo Receive Supplemental Security Income/Payment Yes Santa Clara 20% San Diego High school graduate San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 30% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 112
San Bernardino San Diego More CMC enrollees (47%) report using specialized equipment compared with opt-outs (40%). However, similar proportions of the two populations report requiring assistance to perform common daily activities (36% CMC vs. 33% optouts), or being an overnight patient in a hospital in the past year (26% of CMC vs. 20% of opt outs). Riverside Half of enrollees and opt outs in San Mateo County (50%) report being in fair or poor physical health. Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in San Diego County Overall San Mateo County Santa Clara San Mateo Orange 113
Overall San Mateo County Table SM-5 CMC opt-outs 50% 33% San Mateo 26% 20% Orange Overnight patient in a hospital past 12 months 36% 40% Santa Clara Require assistance for common daily activities 47% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 50% San Bernardino In fair or poor health Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs 114
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara Orange County: Aggregated Results from Years 1 -4 San Mateo Orange 115
Riverside San Bernardino Over eight in ten CMC enrollees and opt outs in Orange County express confidence that they know how to manage their health conditions (83%), can get questions about their health needs answered (83%), and know who to call if they have a health need or question (87%). Los Angeles 1. Beneficiary Confidence Navigating Health Care in Orange County Overall Orange County San Diego Santa Clara San Mateo Orange 116
Overall Orange County Table OR-1 CMC opt-outs 87% Can get questions about your health needs answered (% confident) 83% Santa Clara 87% San Mateo Know who to call if you have a health need or question (% yes) San Diego 83% San Bernardino Know how to manage your health conditions (% confident) Riverside CMC enrollees Los Angeles Beneficiary Confidence Navigating Health Care in Orange County Orange 117
Riverside San Bernardino Large majorities of CMC enrollees in Orange County (between 76% and 87%) are satisfied with the health services they are receiving across the seven areas measured. While in past years there were areas where opt-outs were more satisfied than the enrollees, by 2018 there are no significant differences between groups on any measure of satisfaction. Los Angeles 2. Satisfaction with Health Care Services in Orange County Overall Orange County San Diego Santa Clara San Mateo Orange 118
Overall Orange County Table OR-2 87% 86% 80% Your choice of doctors (% satisfied) 84% 80% San Mateo 77% 83% Orange Your choice of hospitals (% satisfied) Santa Clara 84% San Diego Information health plan gives explaining your benefits (% satisfied) San Bernardino Amount of time doctor/ other staff spend with you (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (1) 119
Overall Orange County Table OR-2 77% Santa Clara 76% 77% San Mateo Your ability to call a health provider regardless of the time of day* (% satisfied) 80% 86% San Diego How long you have to wait to see a doctor when you need an appointment (% satisfied) 83% San Bernardino The way different providers work together (% satisfied) CMC opt-outs Riverside CMC enrollees Los Angeles Satisfaction with Different Aspects of the Health Care Services Beneficiaries Are Receiving (2) Orange * Asked only in Year 2 through 4. 120
San Bernardino San Diego Santa Clara San Mateo Orange Among opt-outs 20% report having a misunderstanding about their health care services or coverage, 17% percent opt-outs report that a doctor they were seeing was not available through their plan, and 15% opt-outs report that they were denied a treatment or referral for another service recommended by a doctor. Eighteen percent opt-outs also report that transportation problems kept them from getting needed care. Riverside Relatively small proportions of CMC enrollees and opt-outs in Orange County say they encountered any of six specific problems with their health services in the recent past. Most commonly reported among enrollees are that a doctor they were seeing was no longer available through their plan (19%), that they had a misunderstanding about their health care services or coverage (17%), or that they were denied a treatment or referral for a service recommended by a doctor. Los Angeles 3. Specific Problems with Health Care Services in Orange County Overall Orange County 121
Overall Orange County Table OR-3 Was denied a treatment or referral for another service recommended by a doctor 12% 15% 18% 10% 9% 10% 7% Orange (among non- English speakers) 14% San Mateo Had trouble communicating with a health provider because of a speech, hearing or other disability Health provider did not speak your language and no interpreter was available 20% Santa Clara Transportation problems kept you from getting needed health care 17% San Diego Had a misunderstanding about your health care services or coverage 19% San Bernardino A doctor you were seeing is not available through your plan CMC opt-outs Riverside CMC enrollees Los Angeles Specific Problems with Health Care Services in Orange County 122
San Mateo Orange About six in ten enrollees (58%) and opt-outs (59%) say they are receiving Supplemental Security Income/Payment from the federal government. Santa Clara Slightly over four in ten CMC enrollees (43%) have not graduated from high school, while 40% opt-outs report this. At the other end of the scale, 15% of enrollees and 21% of opt-outs in the county are college graduates. San Diego Beneficiaries, both enrollees and opt-outs, skew older. Only about one in four enrollees (25%) and one in five opt-outs (22%) are under age 65. San Bernardino Women comprise a somewhat smaller share of enrollees (56%) than among opt -outs (59%). Riverside Almost half of CMC enrollees (47%) and opt-outs (46%) are Latino. However, more enrollees (31%) than opt-outs (26%) are white non-Hispanic. Los Angeles 4. Demographic Characteristics of CMC Enrollees and Opt-outs in Orange County Overall Orange County 123
Overall Orange County Table OR-4 44% Female 41% 56% 25% 65 -74 22% 45% 41% 38% Race/ethnicity White non-Hispanic 31% 26% African American Other/not reported 2% 46% 3% 12% 7% 18% 7% Orange Asian American 47% San Mateo 30% Santa Clara 75 or older Latino San Diego Age Under 65 59% San Bernardino Gender Male CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (1) 124
Overall Orange County Table OR-4 CMC opt-outs Not a high school graduate 40% 43% 19% 14% Some college/trade school 19% 20% 21% 15% No 58% 32% 59% San Mateo Receive Supplemental Security Income/Payment Yes Santa Clara College graduate San Diego High school graduate San Bernardino Education Riverside CMC enrollees Los Angeles Comparing the Demographic Characteristics of CMC Enrollees and CMC Opt-outs (2) 35% Orange Note: Differences between 100% and the sum of percentages for each characteristic equal proportion not reporting an answer. 125
San Bernardino San Diego Santa Clara About the same proportion of enrollees (37%) and opt-outs (38%) say they use specialized equipment, such as a cane, wheelchair, scooter or special bed. However, fewer enrollees (22%) report requiring assistance to perform common daily activities compared with opt-outs (30%). Riverside Fewer enrollees (21%) than opt-outs (37%) in Orange County report having been an overnight patient in the hospital in the past year. This is noteworthy, especially since similarly more enrollees (41%) than opt-outs in Orange County (34%) report being in fair or poor physical health. Los Angeles 5. Health-related Characteristics of CMC Enrollees and Opt-outs in Orange County Overall Orange County San Mateo Orange 126
Overall Orange County Table OR-5 42% 37% 38% San Diego Use specialized equipment, such as a cane, wheelchair, scooter or special bed 37% San Bernardino In fair or poor health CMC opt-outs Riverside CMC enrollees Los Angeles Comparing the Health Characteristics of CMC Enrollees and CMC Opt-outs Santa Clara 22% 30% Overnight patient in a hospital past 12 months 21% 37% San Mateo Require assistance for common daily activities Orange 127
Overall Riverside San Bernardino San Diego Santa Clara San Mateo Orange • IBM SPSS Statistics for Macintosh, Version 21. 0 was used for statistical analyses such as frequencies and chi-squared tests to compare differences across comparison groups within survey year. • IBM SPSS Statistics for Windows, Version 23. 0 was used to weight the data to adjust the polling sample so that it was representative of the target population. Weights were derived using a form of post-stratification weighting known as Raking or RIM weighting permits the adjustment of multiple characteristics in a dataset all at the same time in a way that it keeps the different characteristics proportionate as a whole. The following population estimates were obtained from DHCS in 2017 and used with the SPSS Raking procedure – gender (male, female); language (ASL, Spanish, Cantonese, Mandarin, English, other sign languages); age; and county. Weights were determined separately for the three groups: CMC enrollees, dually eligible beneficiaries who chose to opt-out of the CMC program, and dually eligible beneficiaries in non-participating CMC counties. Los Angeles Methodology 128
Research Team Carrie Graham, Ph. D, MGS, Principal Investigator Pi-Ju (Marian) Liu, Ph. D, Co-Principal Investigator Leslie Ross, Ph. D, Research Specialist Linda Ly, Research Assistant Bethany Lee, Research Assistant University of California, San Francisco Institute for Health and Aging 129
Overall Los Angeles Riverside San Bernardino San Diego Santa Clara For questions or comments, please contact: Carrie Graham, Ph. D, MGS clgraham@berkeley. edu 510 643 -7143 San Mateo Orange 130
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