Involuntary disenrollment from a Medicare managed care plan at an academicmedical center: Effect on patients

OBJECTIVES: Little is known about the impact of mandatory (involuntary) dis enrollment 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 disable d") 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 enro llee decisions to stay in the MCO or return to Medicare fee-for-service. DESIGN: A cross-sectional telephone questionnaire. SETTING: A Medicare managed care plan at two outpatient clinics at an acade mic medical center in Denver, Colorado. PARTICIPANTS: Four hundred fifty enrollees recently notified of termination of their clinic's contract with a Medicare managed care plan were surveyed . MEASUREMENTS: Survey questions on demographics, patient concerns about dise nrollment, and factors associated with staying at the academic medical cent er or switching to another clinic or plan associated with the MCO. RESULTS: Of 371 respondents, 57% switched to another plan within the MCO, i ncluding 65% of the Medicare disabled enrollees and 57% of the Medicare non disabled enrollees. More than 60% of both Medicare disabled and older patie nts who switched felt that it was a significant problem for them. By multiv ariate analysis, age was not associated with switching, but a distant relat ionship 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. Ol der and younger patients cited similar concerns raised by switching, but fi nancial issues were identified as a major concern by more younger patients than older patients (P = .001). CONCLUSIONS: Involuntary disenrollment raised significant concerns for pati ents in a Medicare managed care plan.