Partnering managed care and community-based services for frail elders: the care advocate program.
OBJECTIVE
To describe a demonstration program that uses master's-level care managers (care advocates) to link Medicare managed care enrollees to home- and community-based services, testing whether referrals to noninsured services can reduce service usage and increase member satisfaction and retention.


METHODS
Using an algorithm designed to target frail, high-cost users of Medicare insured healthcare services, the program partners PacifiCare's Secure Horizons and four of its medical groups with two social service organizations.


METHODS
Three care advocates located in two community-based social services agencies using telephone interviews to interact with targeted elders living in the community.


METHODS
Three hundred ninety PacifiCare members aged 69 to 96 receiving care from four PacifiCare-contracted medical groups.


METHODS
The 12-month intervention provides telephone assessment, links to eight types of home- and community-based services, and monthly follow-up contacts.


METHODS
Sociodemographic characteristics of intervention participants, types of service referrals, and acceptance rates.


RESULTS
Lessons learned included the importance of building a shared vision among partners, building on existing relationships between members and providers, and building trust without face-to-face interactions.


CONCLUSIONS
The program builds on current insured case management services and offers a practical bridge to community-based services.
Wilber
Kathleen H
KH
Andrus Gerontology Center, University of Southern California, Los Angeles, California 90028, USA. Wilber@usc.edu
Allen
Douglas
D
Shannon
George R
GR
Alongi
Sam
S
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002140:California; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D006278:Medicare / Q000458:organization & administration; D010344:Patient Advocacy; D017060:Patient Satisfaction; D010865:Pilot Projects; D015397:Program Evaluation; D012017:Referral and Consultation; D012947:Social Work