Baseline data from a longitudinal survey that included 369 Massachusetts adult wheelchair-users showed that those enrolled in a model risk-based, prepaid, managed care program reported significantly fewer problems of access to care; better health outcomes, and fewer secondary conditions, most notably anxiety, depression, fatigue, and chronic pain. There were no significant differences in the use of in-patient or out-patient services or satisfaction with quality of care. First-wave longitudinal data (N=276 survivors [75%]; 90 [79%] in the managed care group) report less difficult access to care (51% vs 39% “not at all” difficult; NS), and better self-assessments of health in the managed care group (43% vs 25% “very good” or “excellent;” 17% vs 42% “fair” or “poor;” p < 0.001); also fewer secondary conditions (Mean [± SD]=5.3 [ ± 3.2 ]vs 5.9 [± 3.1] / person /year; NS) and fewer reports of fatigue (52% vs 62%, p < 0.01), chronic pain (38% vs 54% p < 0.01), and shoulder pain (31% vs 46%, p < 0.02). There were no significant differences in use of in-patient or out-patient services nor satisfaction with overall quality of health care (but with 73% vs 59%, reporting “excellent” or “very good” care). Though with less force than cross-sectional analysis, longitudinal data confirm that the model program achieves better outcomes, compromising neither access nor quality. The experience has implications for efforts to reform the organization, finance, and delivery of care.
Learning Objectives: At the end of the presentation, participants should be able to identify the different outcomes for people with physical impairments affiliated with a model prepaid managed care plan. They should understand the special nature of the model program that limits easy generalization. However, they also should understand some of the implications of the experience for efforts to reform the organization, finance, and delivery of health care for people with impairments
Keywords: Disability Policy, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.