title: Involuntary disenrollment from a Medicare managed care plan at an academic medical center: effect on patients.
abstract: OBJECTIVE
  Little is known about the impact of mandatory (involuntary) disenrollment of patients from Medicare managed care organization (MCO) plans. We hypothesized that involuntary disenrollment raises significant concerns for patients, that younger enrollees (aged less than 65, "Medicare disabled") have different concerns than older patients, and that younger patients respond to termination of their plan within the MCO differently from older patients. We also examined other factors associated independently with enrollee decisions to stay in the MCO or return to Medicare fee-for-service.
  
  
  METHODS
  A cross-sectional telephone questionnaire.
  
  
  METHODS
  A Medicare managed care plan at two outpatient clinics at an academic medical center in Denver, Colorado.
  
  
  METHODS
  Four hundred fifty enrollees recently notified of termination of their clinic's contract with a Medicare managed care plan were surveyed.
  
  
  METHODS
  Survey questions on demographics, patient concerns about disenrollment, and factors associated with staying at the academic medical center or switching to another clinic or plan associated with the MCO.
  
  
  RESULTS
  Of 371 respondents, 57% switched to another plan within the MCO, including 65% of the Medicare disabled enrollees and 57% of the Medicare nondisabled enrollees. More than 60% of both Medicare disabled and older patients who switched felt that it was a significant problem for them. By multivariate analysis, age was not associated with switching, but a distant relationship with one's physician was associated with switching (odds ratio (OR) = 10.2; confidence interval (CI), 1.13-91.09) and having received care at the academic medical center for 1 year or longer (OR = 0.35, 95% CI, 0.17-0.69), postcollege education (OR = 0.34; CI, 0.16-0.69), and black race (OR = 0.29; CI, 0.13-0.68) were independently associated with not switching. Older and younger patients cited similar concerns raised by switching, but financial issues were identified as a major concern by more younger patients than older patients (P = .001).
  
  
  CONCLUSIONS
  Involuntary disenrollment raised significant concerns for patients in a Medicare managed care plan.
authors.affiliation: Division of Geriatrics, University of Colorado Health Sciences Center, Denver, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Morgenstern
authors.forename: R
authors.initials: R
authors.lastname: Gonzales
authors.forename: R J
authors.initials: RJ
authors.lastname: Anderson
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D002755:Choice Behavior; D003120:Colorado; D003284:Contract Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D006278:Medicare / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction; D044469:Racial Groups; D016079:Refusal to Treat; D011795:Surveys and Questionnaires; D014481:United States