Managed Long-Term Care

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2015 Member Satisfaction Survey Summary Report

December 2015

Table of Contents

Executive Summary

Introduction

Methodology

Key Findings

MLTC Plan Evaluation

Quality of Care

Timeliness of Care

Access to Care

Recommendations

Section 1: Introduction

Background

Objectives

Section 2: Methodology

Survey Instrument

Survey Sample

Composite Measures

Section 3: Results

Response Rates

Respondent Demographics

Plan Evaluation/Rating of Health Plan

Quality of Care

Timeliness of Care

Access to Care

Analysis of Composite Measures

Domain 1: Measures Related to MLTC Plan Evaluation

Domains 2-5: Measures Related to Quality, Timeliness, and Access to Care

Analysis of Composite Measures by Subgroup

Comparison by Plan Type (Table B7)

Comparison by Gender (Table B8)

Comparison by Race/Ethnicity (Table B9)

Comparison by Education (Table B10)

Comparison by Age (Table B11)

Comparison by Primary Language (Table B12)

Comparison by Self-Reported Health Status (Table B13)

Section 4: Conclusions and Recommendations

Appendix A. Frequency Tables

Appendix B. Aggregate Tables

Appendix C. Survey Tool


Executive Summary

Introduction

The study assesses the level of satisfaction of members enrolled in New York State´s Medicaid Managed Long Term Care (MLTC) plans. The primary purpose of the study is to provide the New York State Department of Health (NYSDOH) with information regarding member satisfaction with the quality, accessibility, and timeliness of services provided by MLTC plans.

At the time of the initiation of the survey in late 2014, within New York Medicaid, there were three models of MLTC plans: 1) Partially capitated MLTC plans, 2) Program of All-Inclusive Care for the Elderly (PACE) plans, and 3) Medicaid Advantage Plus (MAP) plans. Partial MLTC plans are capitated for providing care management, community-based long-term care services, and nursing home care. The PACE and MAP benefit packages also include inpatient and outpatient care. In view of the continued growth of the MLTC program, the NYSDOH and Island Peer Review Organization (IPRO) considered a satisfaction survey to be warranted. Similar surveys had been conducted in previous years. Results from the 2013 satisfaction survey are cited throughout this report for comparative purposes. Rates cited in this report from 2013 may differ from prior reports, as these rates were updated to reflect changes in the survey questions and responses.

Methodology

The first section of the survey addressed members´ general experience with their managed long-term care plan. The second section dealt with the quality of specific health care services, where members were asked to rate the quality of these services, whether covered by their plan or not. This section also addressed timeliness of some key long-term care services and access to primary health care services. The third section contained general demographic questions (e.g., age, gender, race, education), living arrangements, whether assistance was provided to complete the survey, and questions regarding the status of members´ advance directives.

The survey was made available in English, Spanish, Russian, and Chinese and was mailed to members based upon the primary language designations provided by the NYSDOH. An English version of the survey was included with every non-English mailing. The initial mailing was distributed in December 2014, with a follow up mailing in March 2015.

Inclusion criteria for the eligible population were as follows:

  • Continuously enrolled in an MLTC plan for a minimum of 6 months prior to August 31, 2014
  • MLTC plan enrollees from 45 plans/product lines
    • The breakdown by plan type is as follows: PACE-8, Partially Capitated-29, MAP-8

A sample of 600 enrollees from each plan was selected, plus the entire membership if the plan´s enrollment was less than 600. The final sample was 18,909 enrollees. Exclusions from mailing (e.g. address issues, deceased members) totaled 1,105, leaving a net adjusted population of 17,804 enrollees. Completed and returned surveys totaled 4,592; with a response rate of 26%. Nearly seventy-three percent (73%) of the responses were returned in English; 57% of the respondents consider English to be their primary language.

Key Findings

MLTC Plan Evaluation: Approximately 87% of respondents rated their plan as good/excellent. Nearly the same percentage (86%) reported that their plan always/usually explained services clearly. Compared to 2013 survey results, an increased percentage of respondents reported that their plan answers questions quickly and a larger percentage indicated that they are able to understand the answers.

Quality of Care: Members´ perception of the quality of care received has remained high. Eighty-one percent (81%) of respondents for the most highly utilized providers rated their quality as good/excellent.

Timeliness of Care: Timeliness of care provided by the most utilized providers was found to be high, and in every instance, improved over 2013 survey results. Eighty-two percent (82%) of respondents for the most highly utilized providers rated these services to be always/usually timely.

Access to Care: Nearly 39% of respondents indicated that they are able to get same day urgent appointments with providers; this is somewhat improved over 2013 results, but overall still leaving room for improvement. Nearly 81% of respondents indicated that they are able to get timely regular appointments with providers.

Recommendations

IPRO identified various opportunities based upon survey outcomes, and has made recommendations as follows:

  • The percentage of members rating the quality of medical supplies and equipment as good/excellent, while still high, declined from the 2013 survey. Similarly, declines were also observed with the quality of home health and personal care agencies. It is recommended that plans conduct more in-depth member surveys focused on these services to determine if, in fact, quality issues exist and to determine the nature of these issues. Reviews of complaint and grievance logs may be considered as well, as a means of identifying quality of care issues.
  • The percentage of respondents rating the quality of dental services as good/excellent, while slightly improved from 2013, continues to be among the lowest of the highly utilized services. Member surveys focused on the quality of dental care, and review of dental related complaints and grievances may be warranted.
  • The percentage of respondents indicating that advance directive discussions have taken place, and the percentage of respondents indicating that advance directives are in place, declined slightly from 2013 results. IPRO recommends continued efforts to conduct advance directive performance improvement projects (PIPs), with language and cultural focused interventions wherever appropriate.
  • The percentage of respondents indicating that they had same day urgent access to providers, while improved over the 2013 results, continues to be low. Plans may wish to investigate access issues through possibly interviewing providers to determine exactly how urgent visits are handled. Plans may also choose to interview samples of members to obtain time intervals for urgent appointments, in order to provide outreach to certain providers.
  • The percentage of respondents indicating that family members or caregivers are involved in care planning, while improved over 2013 results, continues to be somewhat low. Family involvement is the member´s choice. However, plans should investigate whether members would like additional family and/or caregiver participation in care planning. Plans may need to consider doing more to foster member and caregiver involvement in care planning.
  • There were some observed race/ethnicity differences with certain ratings. These results may indicate that cultural barriers associated with race, and language barriers, may be playing a role in not being satisfied with certain services and with timely access to them. Plans may consider exploring whether or not there is limited access to service across certain ethnic groups.
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Section 1: Introduction

Background

Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health (NYSDOH). The entire array of services to which an enrolled member is entitled can be received through the MLTC plan the member has chosen. As New York transforms its long-term care system to one that ensures care management for all, enrollment in an MLTC plan may be mandatory or voluntary, depending on individual circumstances.

Enrollment in an MLTC plan is mandatory for those who:

  • Are dual eligible (eligible for both Medicaid and Medicare) and over 21 years of age and need community-based long-term care services for more than 120 days; and
  • Reside in the counties of NYC, Nassau, Suffolk or Westchester. Enrollment

Enrollment in an MLTC plan is voluntary for those who:

  • Are dual eligible and are 18 through 21 years of age, and need community-based long-term care services for more than 120 days and assessed as nursing home eligible; or
  • Are non-dual eligible and over 18 years of age and are assessed as nursing home eligible.

Within New York Medicaid, at the time of survey initiation, there were three models of MLTC plans: 1) partially capitated MLTC plans, 2) Program of All-Inclusive Care for the Elderly (PACE) plans, and 3) Medicaid Advantage Plus (MAP) plans. Partial MLTC plans are capitated for providing care management, community-based long-term care services, and nursing home care. The PACE and MAP benefit packages also include inpatient and outpatient care. The satisfaction survey addressed these three plan models.

The MLTC program has continued to expand, due to mandatory enrollment for certain individuals in need of more than 120 days of community-based long-term care services as described above. Effective in 2015, Fully Integrated Duals Advantage (FIDA) plans have formed. These plans serve dually eligible individuals in need of 120 days of community-based long-term care services. The FIDA benefit package includes State plan Medicaid services, Medicare services, home and community-based waiver services and behavioral health services.

This study assesses the level of satisfaction of members enrolled in New York State´s Medicaid MLTC plans. The primary purpose of the study is to provide the NYSDOH with information regarding member satisfaction with the quality, accessibility, and timeliness of services provided by MLTC plans.

Satisfaction surveys are a key tool for understanding patient perception and improving the delivery of long-term care services, and such surveys are integral to ongoing quality improvement efforts. On both federal and state levels, programs continue to utilize and expand the use of consumer-driven data, based on consumer experiences, to improve the quality of health care delivered to the elderly and, in many cases, chronically ill populations. At the national level, the Centers for Medicare and Medicaid Services (CMS) has collected information on Medicare managed care enrollee consumer satisfaction and experience with health services through the Consumer Assessment of Health Providers and Systems (CAHPS) survey since 1998. This survey includes the following domains:

  • Getting Needed Care
  • Getting Care Quickly
  • Doctors Who Communicate Well
  • Flu Shot Rate
  • Overall Ratings of: Health Care, Health Plan, Doctor, and Specialist

This survey has undergone periodic revisions; in the 2006 survey year for example, data collection was expanded to include satisfaction and experience of members enrolled in a Medicare Advantage Prescription Drug plan. CAHPS surveys are also collected for commercial and Medicaid managed care populations (The NYSDOH administers a biennial Medicaid managed care survey which is largely based on CAHPS).

IPRO has observed that while all NYS MLTC plans conduct internal annual member satisfaction surveys, each plan has developed their own individualized surveys. IPRO reviewed a sample of these surveys. Several of them addressed general satisfaction with plan services and covered courtesy and sensitivity, but specific questions relating to the quality of plan services, timeliness, and access to services were often not addressed. Therefore, IPRO, in conjunction with the NYSDOH, conducted the first member satisfaction survey of New York´s MLTC population in 2007, and again in 2011, 2013, and 2015. Survey results have been positive, with the majority of MLTC respondents satisfied with their health plan. It is anticipated that this survey will be administered every other year going forward.

Objectives

In early 2014, IPRO and the NYSDOH developed a plan to evaluate MLTC member satisfaction with the services provided by their MLTC plan. Specific objectives were to assess whether:

  • MLTC enrollees are satisfied with:
    • quality of health care services;
    • access to primary health care services;
    • timeliness of primary health care and long-term care services;
  • There are differences in care and in satisfaction of care, between the three principal MLTC plan models (PACE, partially capitated and MAP plans) and between different age groups, reported state of health, race/ethnicity and primary language;
  • There has been a change in members´ perception of quality of care and overall satisfaction since the last satisfaction survey in 2013.
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Section 2: Methodology

Survey Instrument

To achieve the objectives, a scannable survey instrument was created. To facilitate comparisons to the 2013 survey, the 2015 survey contained all of the questions from the 2013 survey, with the addition of three (3) new questions concerning the following: whether the health plan had explained the Consumer Directed Personal Assistance option, quality of mental and emotional health, and how well the members speak English.

The survey was comprised of three sections. The first section addressed members´ general experience with their managed long-term care plan, which included questions on plan of care involvement, courtesy, and timeliness of responses with complaints and grievances. The second section dealt with the quality of specific health care services, including both primary and long-term care services, where members were asked to rate the quality of these services, whether covered by their plan or not. This section also addressed timeliness of some key long-term care services and access to primary health care services. The third section contained general demographic questions (e.g., age, gender, race, education). This section also included questions pertaining to living arrangements and whether assistance was provided in completing the survey, as well as questions regarding the status of members´ advance directives.

An English version was prepared and translated into Spanish, Russian, and Chinese, and mailed to members based upon the primary language designations provided by the NYSDOH. An English version of the survey was included with every non-English (Spanish, Russian, Chinese) mailing. The initial mailing was distributed in December 2014, with a follow-up mailing in March 2015.

Survey Sample

To identify the eligible population for the survey, inclusion criteria were as follows:

  • Continuously enrolled in a MLTC plan for a minimum of 6 months prior to August 31, 2014.
  • MLTC plan enrollees from 45 plans/product lines. The breakdown by type of MLTC plan is as follows: PACE – 8, Partially Capitated – 29, MAP – 8.

The NYSDOH provided the enrollee file for the survey after sampling. A sample of 600 enrollees from each plan had been selected, plus the entire eligible membership if the plan´s enrollment was less than 600. The 600-member sample size had been utilized in the 2013 survey. The final sample for mailing was 18,909 enrollees.

Composite Measures

Composite measures of survey items were computed to obtain a meaningful summary of member responses in each of six domains, which include: MLTC Plan Evaluation, Quality of Providers and Long-Term Care Services, Timeliness of Providers and Long-Term Care Services, Access to Care for Urgent Appointments, Access to Care for Regular Appointments, and Advance Directives. Each domain is comprised of individual survey items, composite measures, or a combination of both. Composite measures were created by combining survey items that measure the same dimension of the health care plans1.

Using the proportional scoring method, composite scores were computed, representing the average proportion of members responding to the most positive category, or top box, for the survey items included in the composite, excluding missing data. For example, for survey items requiring the respondent to answer "Always," "Usually," "Sometimes," or "Never," the calculated score reflects the average proportion of respondents who answered "Always/Usually;" and for survey items requiring the respondent to answer "Excellent," "Good," "Fair," or "Poor," the calculated score reflects the average proportion of respondents who answered "Excellent/Good." The z-test was used to compare percentages for single survey items, and t-tests were used to compare average proportions for composite measures.

The six domains are defined as follows:

Domain 1: MLTC Plan Evaluation
Individual item Q3. The plan always/usually explains all of their services clearly
Composite My family member (or caregiver) and I are always/usually involved in making decisions about my plan of care
  • Q4. I am always/usually involved in decisions about plan of care
  • Q5. Family member or caregiver always/usually involved in making decisions about plan of care
Composite The plan always/usually provided helpful, timely, and courteous customer service when I (or my caregiver or family members) have called with a question, needed help, or had a complaint or grievance
  • Q7. I always/usually spoke with a person quickly when I called the plan with a question or for help or with a complaint or grievance
  • Q8. My questions were always/usually answered quickly
  • Q9. I was always/usually able to understand the answers
  • Q10. I was always/usually treated with politeness and respect
  • Q11. I (or my caregiver or family members) called the plan with a complaint or grievance and it was always/usually handled to my satisfaction
Individual item Q12. Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I´ve been taking
Individual item Q13. Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option
Composite The plan is excellent/good in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home
  • Q14a. The plan is excellent/good in assisting my family to ensure that I take my medications the way my doctor wants me to
  • Q14b. The plan is excellent/good in assisting my family and I to manage my illness, such as high blood pressure or diabetes
  • Q14c. The plan is excellent/good in assisting my family and I when I am feeling sad and lonely
  • Q14d. The plan is excellent/good in assisting my family and I so that I can stay at home and not have to live in a nursing home
Individual item Q15. Overall, my MLTC plan is excellent/good
Domain 2: Quality of Providers and Long-Term Care Services
Composite Excellent/good quality of care provided by the most utilized2 providers/services
  • Q16. Regular doctor
  • Q17. Dentist
  • Q18. Eye Care
  • Q19. Foot Doctor
  • Q20a. Home Health Aide, Personal Care Aide
  • Q20b. Home Health Agency, Personal Care Agency
  • Q21. Care Manager/Case Manager
  • Q22a. Regular Visiting Nurse/Registered Nurse
  • Q22b. Covering/On-call nurse
  • Q23. Physical Therapist
  • Q24. Occupational Therapist
  • Q25. Speech Therapist
  • Q26. Social Worker
  • Q27. Medical Supplies and Equipment
  • Q28. Audiology/Hearing Aids
  • Q29. Home Delivered Meals/Meals on Wheels
  • Q30. Meals served at the Day Health Center
  • Q31. Day Health Center Activities
  • Q32. Transportation Services
  • Q33. Nursing Home
  • Q34. Pharmacy Services
  • Q35. Nutritionist
Domain 3: Timeliness of Providers and Long-Term Care Services
Composite Timely care always/usually provided by the most utilized2 providers/services
  • Q36. Home Health Aide, Personal Care Aide
  • Q37. Care Manager/Case Manager
  • Q38a. Regular Visiting Nurse/Registered Nurse
  • Q38b. Covering/On-call nurse
  • Q39. Physical Therapist
  • Q40. Occupational Therapist
  • Q41. Speech Therapist
  • Q42. Social Worker
  • Q43. Home Delivered Meals/Meals on Wheels
  • Q44a. Transportation: TO Day Center
  • Q44b. Transportation: FROM Day Center
  • Q44c. Transportation: TO the doctor
  • Q44d. Transportation: FROM the doctor
  • Q45. Medical Supplies and Equipment
  • Q46. Pharmacy Services
  • Q47. Audiology/Hearing Aids

____________________________

2. It is likely that some services, such as home health care and transportation,are utilized far more frequently than other services, such as speech therapy. Inclusion in the composite depended uponthe total frequency of responses for each survey item, excluding "Not-applicable" responses.  2

Domain 4: Access to Care for Urgent Appointments
Composite I was able to get an appointment within the same day to see my provider when I needed care right away in the past 6 months
  • Q48. Regular doctor
  • Q49. Dentist
  • Q50. Eye Care
  • Q51. Foot Doctor
  • Q52. Audiology/Hearing Aids
Domain 5: Access to Care for Regular Appointments
Composite I was always/usually able to get a regular appointment as soon as I thought I needed one
  • Q53. Regular doctor
  • Q54. Dentist
  • Q55. Eye Care
  • Q56. Foot Doctor
  • Q57. Audiology/Hearing Aids
Domain 6: Advanced Directives
Individual item Q71. The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so
Individual item Q72. I have a legal document appointing someone to make decisions about my health care if I am unable to do so
Individual item Q73. The health plan has a copy of this document
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Section 3: Results

Response Rates

Of the 18,909 surveys that were mailed, 1,105 were returned as undeliverable due to either mailing address issues or the member was deceased. This yielded an adjusted population of 17,804. A total of 4,592 surveys were completed, with an overall response rate of 26%. In 2013, 2,522 surveys were completed for a response rate of 27%.

Table 1 displays the response rates by plan type. The response rates were as follows: PACE (30%), MAP (29%), and Partially Capitated (25%), with an average response rate of 26%. Table 2a shows the response rates by language. Non-English responses comprised 27% of total responses.

Table 2b provides a summary of all responses per primary language.

Table 3 displays survey responses by individual plan. Response rates differed by plan, ranging from 13% to 51%.

Table 1: Survey Responses by Plan Type
  Partially Capitated PACE MAP TOTAL
N Percent N Percent N Percent N Percent
Surveys mailed 14,162   2,132   2,615   18,909  
      Less exclusions: 774 5% 199 9% 132 5% 1,105 6%
            Address issues 704 5% 172 8% 122 5% 998 5%
            Deceased 50 0.4% 21 1% 7 0.3% 78 0.4%
            Other reason 20 0.1% 6 0.3% 3 0.1% 29 0.2%
Adjusted Population 13,388   1,933   2,483   17,804  
      Total # Surveys Completed 3,306 25% 574 30% 712 29% 4,592 26%
Table 2a: Language Responses by Plan Type
  Partially Capitated PACE MAP TOTAL
N Percent N Percent N Percent N Percent
Completed in English 2,264 68% 514 90% 565 79% 3,343 73%
Completed in a Language Other Than English 1,042 32% 60 10% 147 21% 1,249 27%
        Chinese 305 29% 24 40% 8 5% 337 27%
        Russian 419 40% 8 13% 4 3% 431 35%
        Spanish 318 31% 28 47% 135 92% 481 39%
Total # Surveys Completed 3,306   574   712   4,529  
Table 2b: Survey Response Rates by Language
  N Percent
ENGLISH
English Surveys Mailed 11,791  
        Less exclusions 1 751 6%
        Adjusted English Survey Population 11,040  
        Completed English Surveys 3,343 30%
SPANISH
Spanish Surveys Mailed 3,574  
        Less exclusions 2 213 6%
        Adjusted Spanish Survey Population 3,361  
        Completed Spanish Surveys 481 14%
RUSSIAN
Russian Surveys Mailed 1,877  
        Less exclusions 3 77 4%
        Adjusted Russian Survey Population 1,800  
        Completed Russian Surveys 431 24%
CHINESE
Chinese Surveys Mailed 1,667  
        Less exclusions 4 64 4%
        Adjusted Chinese Survey Population 1,603  
        Completed Chinese Surveys 337 21%

1. English exclusions due to address issues (660), member deceased (68), member no longer enrolled (4), and other reason (19). 1
2. Spanish exclusions due to address issues (205), member deceased (6), and member no longer enrolled (2). 2
3. Russian exclusions due to address issues (73), member deceased (2), and other reason (2). 3
4. Chinese exclusions due to address issues (60), member deceased (2), member no longer enrolled (1), and other reason (1). 4

Table 3: Survey Responses by Plan
Health Plan Adjusted Population No. of Respondents Percent
Partially Capitated
AETNA BETTER HEALTH 575 163 28%
AGEWELL NEW YORK 567 153 27%
ALPHACARE 229 49 21%
AMERIGROUP 570 128 22%
ARCHCARE COMMUNITY LIFE 562 134 24%
CENTERLIGHT SELECT 561 126 22%
CENTERS PLAN FOR HEALTHY LIVING 562 147 26%
ELANT 405 129 32%
ELDERPLAN 564 136 24%
ELDERSERVE 570 123 22%
EXTENDED MLTC 162 39 24%
FIDELIS CARE AT HOME 573 159 28%
GUILDNET 568 132 23%
HAMASPIK CHOICE 114 26 23%
HIP OF GREATER NEW YORK 566 125 22%
INDEPENDENCE CARE SYSTEMS 578 150 26%
INTEGRA 577 173 30%
METROPLUS 424 117 28%
MONTEFIORE HMO 166 40 24%
NORTH SHORE-LIJ PLAN 468 131 28%
SENIOR HEALTH PARTNERS INC 569 125 22%
SENIOR NETWORK HEALTH 360 94 26%
SENIOR WHOLE HEALTH 559 108 19%
TOTAL AGING IN PLACE PROGRAM 95 27 28%
UNITED HEALTHCARE 534 109 20%
VILLAGE CARE 557 127 23%
VNA HOMECARE OPTIONS 201 61 30%
VNS CHOICE 573 135 24%
WELLCARE 579 140 24%
TOTAL 13,388 3,306 25%
PACE
ARCHCARE SENIOR LIFE 245 62 25%
CENTERLIGHT PACE 572 163 28%
CHS BUFFALO LIFE 128 60 47%
COMPLETE SENIOR CARE 83 42 51%
EDDY SENIOR CARE 96 30 31%
INDEPENDENT LIVING FOR SENIORS 372 80 22%
PACE CNY 352 113 32%
TOTAL SENIOR CARE 85 24 28%
TOTAL 1,933 574 30%
MAP
AMERIGROUP MAP 7 1 14%
ELDERPLAN MAP 569 144 25%
FIDELIS MAP 155 40 26%
GUILDNET MAP 452 134 30%
HEALTHFIRST MAP 583 144 25%
HIP OF GREATER NEW YORK MAP 504 186 37%
SENIOR WHOLE HEALTH MAP 16 2 13%
VNS CHOICE PLUS MAP 197 61 31%
TOTAL 2,483 712 29%
GRAND TOTAL 17,804 4,592 26%

Respondent Demographics

Survey demographic results can be found in Appendix A, Table A6.

The demographic profiles of the 2013 and 2015 populations were very similar. About 75% of respondents in 2015 were female (75% in 2013), and 86% were 65 years of age or older (83% in 2013). Approximately half of respondents (2013: 47%, 2015: 52%) had at least a high school diploma.

English was the primary language for 57% of the 2015 respondents (51% in 2013), with Spanish as the next most common language at 18% (23% in 2013), while the rest reported a primary language of Chinese (2013: 12%, 2015: 9%), Russian (2013: 8%, 2015: 11%), and other languages (2013: 4%, 2015: 6%). Overall, the percentage of respondents that do not speak English as their primary language decreased from 49% in 2013 to 43% in 2015.

Sixty percent of respondents rated their current state of health as poor/fair (66% in 2013), 25% rated their health as good (27% in 2013), and 15% as very good/excellent (6% in 2013). Sixty-two percent of the respondents were very much/quite a bit content with their quality of life (60% in 2013).

The vast majority of respondents live at home (2013: 97%, 2015: 97%), and approximately half live alone (2013: 49%, 2015: 48%). Approximately two-thirds of respondents reported that they received assistance in completing the survey (2013: 65%, 2015: 65%), mostly from family members (2013: 58%, 2015: 65%).

Plan Evaluation/Rating of Health Plan

Section 1 of the survey consisted of questions concerning members´ experience with their MLTC plan.

Full frequency distribution tables can be found in Appendix A (Tables A1-A6), while aggregate tables can be found in Appendix B (Tables B1-B13).

Table B1 compares responses from both survey years, which shows that the level of satisfaction among 2013 and 2015 respondents remained high. Other notable findings were as follows:

  • Eighty-seven percent (87%) rated their plan as excellent/good.
  • Eighty-six percent (86%) reported that their plan always/usually explained services clearly, a significant improvement from the 2013 rate (81%).
  • The majority of members reported that they were always/usually involved in decisions about their plan of care. Compared to 2013, the percentage was significantly higher in 2015 (72% vs. 77%). In addition, 64% of members reported that family members (or caregivers) were always/usually involved in these decisions, which is a significant increase from the 2013 percentage (60%).
  • In the 2015 survey, about half of the members (48%) reported that they called the plan with a question or complaint, significantly lower than in 2013 (65%). Of these respondents:
    • 74% said that they always/usually spoke with a person quickly;
    • 75% said their questions were always/usually answered quickly;
    • 81% said they were always/usually able to understand the answers provided;
    • 92% said they were always/usually treated with politeness and respect;
    • 68% said their complaints were always/usually handled to their satisfaction;
    • All of these rates were significantly higher than in 2013 (49%, 53%, 61%, 84%, and 37% respectively).
  • About 9 out of 10 respondents (94%) reported that someone from the health plan had asked to see all of the prescriptions and over-the-counter medicines they were taking, which is a significant percentage increase from 2013 (88%). This would appear to be a positive indication of the plans´ efforts to help members manage their medications.
  • Eighty-nine percent (89%) reported that their plan has been excellent/good at helping them to take medications the way their doctor wants them to, and 72% reported that their plan has been excellent/good at helping when they were feeling sad and lonely. This would appear to demonstrate that the plans have been effective in providing members with self-management support and collaborating with members and their families to improve members´ health.
  • In 2015, 93% of respondents rated their plan as excellent/good at helping them stay at home and not at a nursing home.

Advance directives are considered an important component in the overall care of the long-term care population. Sixty- seven percent of the respondents reported that their health plan has talked to them about appointing someone to make health care decisions for them if they are unable to do so, and 58% reported having a legal document appointing someone to make health care decisions on their behalf in the event that they are unable to do so. Of the latter, a large majority (79%) said that their health plan has retained a copy of the document. Figure 1 displays the rates for each measure as compared to 2013.

Figure 1: Advance Directives
Figure 1: Advance Directives

Quality of Care

In Section 2A of the survey, members were asked to rate the quality of services and supplies they received. Frequency distributions for the 22 Quality of Care items can be found in Table A2.

Table B2 displays the rank ordered positive (excellent/good) ratings given by members pertaining to quality of care compared by survey year. Members´ perception of the quality of the care they received has remained high in 2015. Other notable findings from this section include:

  • Eight (8) out of the 22 care providers listed had at least 80% of the respondents giving an excellent/good rating for quality in 2015 (compared to 9 out of 22 in 2013), including highly utilized services such as primary care physicians (PCPs) (91%); pharmacy services (91%); home health aide (87%); visiting nurse (83%); care manager (83%); foot doctor (83%); medical supplies/equipment (82%); and eye care professional (81%).
  • The following providers and services all received significantly higher quality of care ratings as compared to 2013 results: meals served at the day health center (70% vs. 78%), home delivered meals/Meals on Wheels (66% vs. 77%), nursing home (64% vs. 77%), and speech therapist (56% vs. 72%).
  • Medical supplies/equipment (86% vs. 82%) received a significantly lower quality of care rating as compared to 2013.
  • Audiology and hearing aids received the lowest quality of care rating at 68%.

Timeliness of Care

In Section 2B of the survey, members were asked to rate how often the services were on time or if they were able to see the provider at the scheduled time. Frequency distributions for the 16 items in this section can be found in Table A3.

Table B3 displays the rank ordered positive (always/usually) ratings given by members compared by survey year.

The majority of members perceived the timeliness of care to be always/usually on time. For nearly every type of care provider, with the exception of speech therapists, there was a statistically significant increase in the perception of timeliness of care among members. Every care provider type demonstrated a percentage above 50%. Eight (8) of the 16 provider types had at least 80% of respondents giving an always/usually rating for timeliness as compared to 2013, including: pharmacy services (77% vs. 92%); home health aide (78% vs. 92%); transportation to the day center (63% vs. 84%); medical supplies/equipment (70% vs. 83%); transportation from the day center (65% vs. 83%); care manager (69% vs. 83%); visiting nurse (70% vs. 81%); and transportation to the doctor (69% vs. 81%). Most notably, all the ratings for every type of care provider increased by at least 10 percentage points; the smallest increase was 10 percentage points (Meals on Wheels and covering/on-call nurse) and the largest increase was 21 percentage points (transportation to the day center).

Out of all the highly utilized services, speech therapists were least likely to receive a high rating for timeliness. While speech therapists did not achieve a statistically significant increase in percentage of members who rated them as always/usually on time from 2013 to 2015, there was still a notable increase of 11 percentage points.

Access to Care

In Section 2C of the survey, members were asked to indicate how long they generally had to wait for urgent and regular appointments for frequently utilized providers. Tables A4 and A5 provide frequency distributions for these survey items.

Timely access to regular appointments was defined as obtaining an appointment with a provider as soon as a member felt they needed an appointment. Timely access to urgent appointments was defined as obtaining an appointment on the same day that the member needed care. Tables B4 and B5 display the rank ordered results for timely access to urgent and regular appointments compared by survey year.

Table B4 shows that for urgent appointments, half of the respondents were able to obtain a same day appointment with their primary care physician (PCP) (50%). Timely access to urgent appointments was even less likely for foot doctors (34%), eye care (33%), audiologists (32%), and dentists (29%). Although the ratings remain at or below 50% for all provider types, compared to 2013, foot doctors (26% vs. 34%) and eye care (22% vs. 33%) both demonstrated significantly increased ratings. Overall, respondents gave higher ratings with regard to timely access to urgent appointments compared with the 2013 survey.

Table B5 shows that for regular appointments, respondents were most likely to have timely access to regular appointments with PCPs (88%); foot doctors (80%), eye care (79%), dentists (73%), and audiologists (68%) ranked lower in this regard. It should be noted that for 2015, the questions and responses regarding timely access to regular appointments were changed from the 2013 survey. In 2013, the question asked "In the past 6 months, when you called for a regular appointment, how long did you generally have to wait between making an appointment and seeing provider?" and the responses were "Less Than 1 Month", "1 to 3 Months", and "Longer Than 3 Months". For the 2015 survey, the question asked "In the past 6 months, when you called for a regular appointment, how often did you get an appointment as soon as you thought you needed?" and responses were "Always", "Usually", "Sometimes", and "Never". Due to the changes in the questions and responses, a comparison to the 2013 rates cannot be performed.

Analysis of Composite Measures and Individual Survey items within Domains

Composite measures of survey items were computed to obtain a meaningful summary of member responses in each of the following six domains:

  • Domain 1 – MLTC Plan Evaluation: Consists of a combination of four (4) individual survey items and three (3) composite measures, and includes Questions 3-5 and 7-15. Questions 4 and 5 were combined to create a composite measure (Composite 1a), as were Questions 7-11 (Composite 1b) and Questions 14a-14d (Composite 1c). All other questions in this group were reported as individual survey items. Collectively, these composites, as well as the individual survey items, assess the members´ general experience with the care plan, including plan of care involvement, and courtesy and timeliness of responses when they called the plan. For Composite 1a and Composite 1b, the score represents the average proportion of respondents who answered "Always/Usually", and for Composite 1c, the score represents the average proportion of respondents who answered "Excellent/Good."
  • Domain 2 – Quality of Providers and Long-Term Care Services: Consists of a single composite measure and includes Questions 16-35. This domain evaluates the quality of care provided by long-term care providers and services, and consists of 22 provider and service types. The composite score for this domain reflects the average proportion of respondents who rated the quality of the most utilized providers and services as excellent/good.
  • Domain 3 – Timeliness of Providers and Long-Term Care Services: Consists of a single composite measure including Questions 36-47, and evaluates the timeliness of care provided by long-term care providers and services. This composite consists of 16 provider and service types. The composite score for this domain reflects the average proportion of respondents who rated the timeliness of the providers and services as always/usually timely.
  • Domain 4 – Access to Care for Urgent Appointments: Consists of a single composite measure, which assesses the respondents´ ability to get an appointment within the same day when care was needed right away. There are five (5) measures within the composite representing five (5) provider types: PCP, dentist, eye care, foot doctor, and audiology. The composite score reflects the average proportion of respondents who reported that they always/usually could get an appointment within the same day.
  • Domain 5 – Access to Care for Regular Appointments: Consists of a single composite measure assessing the ability of respondents to get a regular appointment as soon as they thought they needed one. There are five (5) measures included in the composite which represent five (5) provider types: PCP, dentist, eye care, foot doctor, and audiology. The composite score reflects the average proportion of respondents who reported that they always/usually were able to get a regular appointment as soon as they thought they needed one.

Domain 1: Measures Related to MLTC Plan Evaluation (Table B6)

  • In 2015, 70% of respondents said they, along with family members or caregivers, were always/usually involved in making decisions about their plan of care, a significantly higher rate than in 2013 (66%).
  • Seventy-nine percent (79%) reported that they always/usually received helpful, timely, and courteous customer assistance when they called the plan with a question or complaint.
  • Seventy-five percent (75%) said the plan had explained the Consumer Directed Personal Assistance option.
  • Eighty-four percent (84%) reported that the plan was excellent/good in helping members with managing medications and illnesses, as well as feeling sad or lonely and helping members remain in their homes as opposed to a nursing home.
  • In 2015, 86% reported that the plan always/usually explained services clearly and 94% said the plan had asked to see all prescriptions and medications. Both these rates demonstrate a significant increase as compared to 2013.
  • Overall, 87% rated the health plan as excellent/good.

Figure 1 displays the rates for each measure as compared to 2013.

Figure 1: MLTC Plan Evaluation (Domain 1)
Figure 1: MLTC Plan Evaluation (Domain 1).

*         Indicates a rate significantly higher than 2015. p<.001.
+         Questions and/or responses changed for 2015. No comparison can be made.
++         New question in 2015.
1         Indicates a single survey item. Significance testing for single items was done using a z-test.
2         Indicates a composite measure. Significance testing for composite measures was done using the Student´s t-test.

Domains 2-5: Measures Related to Quality, Timeliness, and Access to Care (Table B6)

  • About 81% of respondents rated the quality of providers and services as excellent/good, basically unchanged from 2013.
  • About 82% of respondents rated the overall timeliness of care as always/usually timely, significantly higher than in 2013 (67%).
  • About 39% of respondents reported that they were always/usually able to get an appointment within the same day, significantly higher than in 2013 (34%).
  • Additionally, 81% of respondents were always/usually able to get a regular appointment with their doctor.

Figure 2 displays the rates for Domains 2-5 as compared to 2013.

Figure 2: Quality, Timeliness, and Access to Care (Domains 2-5)
Figure 2 displays the rates for Domains 2-5 as compared to 2013.

* Indicates a rate significantly higher than 2013. P<.001
+ Questions and/or responses changed for 2015. No comparison can be made.

Analysis of Composite Measures by Subgroup

Comparisons between subgroups were also performed on the selected survey items and composites that comprise each domain to determine which subgroups of the managed long-term care population were most or least satisfied with the quality, timeliness, and access to care in 2015. The subgroups included: plan type, gender, race/ethnicity, education level, age, primary language spoken, and self-reported health status.
Comparison tables can be found in Appendix B, and significant differences in each subgroup are noted as follows:

Comparison by Plan Type (Table B7)

  • On average, Partially Capitated plan members were more likely than MAP plan members to report always/usually receiving helpful, timely, and courteous customer service when they called the plan with a question, complaint, or grievance (80% vs. 73%).
  • PACE plan members were less likely to report that someone at the plan had explained the Consumer Directed Personal Assistance option to them since joining the plan compared to Partially Capitated and MAP (PACE: 58% vs. Partially Capitated: 77%, MAP: 74%).
  • PACE plan members were more likely to report that providers and long-term care services were always/usually on time (PACE: 86% vs. Partially Capitated: 82%, MAP: 80%).
  • Partially Capitated plan members were less likely to report that the plan had talked to them about appointing someone to make decisions about health care if they are unable to (Partially Capitated: 63% vs. PACE: 77%, MAP: 75%).
  • PACE plan members were more likely to report having legal documentation appointing someone to make health care decisions for them, while Partially Capitated plan members were least likely (PACE: 84% vs. MAP: 61% vs. Partially Capitated: 53%).
  • PACE members were more likely to report that the health plan had a copy of the legal document (PACE: 94% vs. Partially Capitated: 75%, MAP: 71%).

Comparison by Gender (Table B8)

  • About 69% of female respondents reported that someone from the health plan had talked to them about appointing someone to make health care decisions for them if they are unable to do so, significantly higher than male respondents (62%).
  • In addition, female respondents were more likely than male respondents to report having legal documentation appointing someone to make health care decisions (61% vs. 52%).

Comparison by Race/Ethnicity (Table B9)

  • On average, white respondents were more likely than black respondents to report that their family members or care givers were always/usually involved in making decisions about health care (73% vs. 66%).
  • Additionally, white respondents were more likely than black respondents to report always/usually receiving helpful, timely, and courteous customer service when they called the plan with a question, complaint, or grievance (82% vs. 74%).
  • When asked if the plan was excellent/good at helping members with medication management, managing illness, feeling sad and lonely, and staying in their homes instead of a nursing home, white respondents were more likely to rate the plan as excellent/good, significantly higher than Asian respondents (86% vs. 80%).
  • Overall, 85% of white respondents rated the quality of care they received as excellent/good, significantly higher than black and Asian respondents (77% and 75%, respectively).
  • In addition, 86% of white respondents rated the timeliness of care as excellent/good, while 78% of black respondents and 77% of Asian respondents rated the timeliness as excellent/good. The rate for white respondents was significantly higher than those for black and Asian respondents.
  • Eighty five percent (85%) of white respondents reported that they were always/usually able to get a regular appointment with their doctors as soon as they thought they needed one. This rate is significantly higher than both black and Asian respondents (79% and 74%, respectively).
  • Of the Asian respondents, 42% reported that they had legal documentation appointing someone to make health care decisions if they are unable to, significantly lower than any other group (White: 64%, Black: 59%, Other: 65%).
  • Additionally, 69% of black respondents reported that their health plan had a copy of their advance directives, representing a significantly lower rate than both white and Asian respondents (85% and 79% respectively).

Comparison by Education (Table B10)

  • Respondents with a level of education less than high school were more likely to report that the plan had explained the Consumer Directed Personal Assistance option than respondents with at least a high school diploma. (79% vs. 70%).
  • Additionally, 71% of respondents with a level of education less than high school reported that the plan had talked to them about appointing someone to make health care decisions if they are unable to do so, significantly higher than respondents with at least a high school diploma (65%).

Comparison by Age (Table B11)

  • Respondents over the age of 65 were more likely to report that their family member or care giver were involved in making decisions about health care, significantly higher than respondents ages 18-64 (72% vs. 63%).
  • Additionally, respondents over age 65 were more likely to have legal documentation appointing someone to make health care decisions (60% vs. 50%).

Comparison by Primary Language (Table B12)

  • Non-English-speaking respondents were more likely to report that the health plan had explained the Consumer Directed Personal Assistance option as compared to respondents whose primary language is English (83% vs. 67%).
  • Forty two percent (42%) of Non-English-speaking respondents reported that they could get urgent appointments with their doctors the same day, significantly higher than English speaking respondents (36%).
  • When asked if members had legal documentation appointing someone to make health care decisions for them, 68% of English-speaking respondents reported they did have legal documents, while 44% of Non-English-speaking respondents reported they had legal documents. The rate for English speaking respondents was significantly higher.

Comparison by Self-Reported Health Status (Table B13)

  • Ninety percent (90%) of respondents who rated their current state of health as excellent/very good reported that the health plan always/usually explained all of their services clearly, significantly higher than respondents who rated their current state of health as good/fair/poor (83%).
  • When asked if family members or caregivers were involved in making health care decisions with the members, respondents who rated their current state of health as excellent/very good were more likely to respond positively (always/usually) than respondents who rated their current state of health as good/fair/poor (73% vs. 68%).
  • In regard to receiving helpful, timely, and courteous customer service when members called the plan with a question, complaint, or grievance, 85% of respondents who rated their current state of health as excellent/very good reported they always/usually received helpful, timely, and courteous customer service while 74% of respondents who rated their current state of health as good/fair/poor reported the same. The rate for respondents with excellent/very good health was significantly higher.
  • Eighty-nine percent (89%) of respondents who rated their current state of health as excellent/very good reported the plan was excellent/good at helping them with medication management, managing illnesses, feeling sad and lonely, and staying in their own home as opposed to a nursing home. Comparatively, only 81% of respondents who reported their health status as good/fair/poor responded to these survey items with an excellent/good rating, a significantly lower rate.
  • Overall, 93% of respondents who rated their current state of health as excellent/very good rated their MLTC plan as excellent/good while 83% of respondents who rated their current state of health as good/fair/poor rated their MLTC plan as excellent/very good.
  • In regard to quality of care, 78% of respondents who rated their current state of health as good/fair/poor rated quality as excellent/good, significantly lower than respondents who rated their current state of health as excellent/very good (86%).
  • Eighty-five percent (85%) of respondents who rated their current state of health as excellent/very good reported that providers and services were always/usually on time, significantly higher than respondents who rated their current state of health as good/fair/poor (80%).
  • Respondents who rated their current state of health as excellent/very good were more likely to report always/usually being able to get regular appointments with their doctors as soon as they thought they needed it (84% vs. 80%).
  • Respondents who rated their current state of health as excellent/very good were more likely to report that they had legal documentation appointing someone to make health care decisions if they are unable to do so (64% vs. 55%).
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Section 4: Conclusions and Recommendations

Overall survey findings were favorable. The tables presented in this report indicate that the majority of MLTC respondents are evidently satisfied with their MLTC plan. The majority of members rated the quality of MLTC services to be good or excellent and the majority indicated that providers and services are always or usually on time. It is encouraging to see continued high satisfaction rates for such critical long-term care services as visiting nurses and care managers. Survey results also indicate that certain services reflected notable quality improvement ratings as compared to the 2013 survey, among these were congregate meals, home delivered meals, and speech therapy.

The percentage of respondents indicating that services were always/usually explained clearly represented a notable increase from 2013. In addition, results indicated that fewer respondents were calling plans with questions or for help, likely because of the improvement in explaining services clearly. Moreover, larger percentages of respondents in the 2015 survey indicated that they were able to speak with a representative quickly, get answers quickly, and understand answers. A larger percentage of respondents indicated that plans are reviewing prescriptions and over the counter medications, likely indicative of improvements in medication management initiatives.

Specific observations and recommendations were as follows:

  1. IPRO observed that the percentage of members rating the quality of medical supplies and equipment as good/excellent, while still high, declined from the 2013 survey (86% to 82% - Table B2).

    Plans may choose to conduct more in-depth member surveys focused on this service to determine if, in fact, quality issues exist and to determine the nature of these issues. These surveys can be used as baseline data to determine if PIPs focusing on this service is warranted. Reviews of complaint and grievance logs may be considered as well, as a means of identifying quality of care issues.
  2. The percentage of respondents rating the quality of dental services as good/excellent, while slightly improved from 2013 (71% to 73%), continues to be among the lowest of the highly utilized services (Table B2).

    Member surveys focused on the quality of dental care may be warranted, to identify issues, and to determine if there are access issues with these providers as well. Reviews of complaint and grievance logs may also be considered as a means of identifying problems with dental networks.
  3. Audiology / hearing aids had the lowest good/excellent quality of care ratings, at 68%, versus 65% in 2013 (Table B2).

    As with dental services, member surveys focused on the quality of these services may be warranted, as are reviews of complaints and grievances involving audiology services, to assist in determining if outreach to these providers is necessary.
  4. The percentage of respondents indicating that the health plan spoke to them about appointing someone to make decisions about their health if they are unable to do so, and the percentage of respondents indicating that they have a legal document (advance directive) in place, declined slightly from 2013 results (Table B1). PACE and MAP plans continue to exhibit higher rates of these discussions and advance directive procurement than partially capitated plans (Tables A6, B7). Whites, blacks, and respondents who identified as "other" reported higher rates of advance directives in place than Asians (Table B9).

    As noted in prior survey findings, a number of partially capitated plans have been addressing advance directives over the years by undertaking PIPs which focus on advance directive discussion as well as procurement. Project interventions have included:
    1. Increased social worker involvement (language and culture specific where applicable)
    2. Language and culture specific member education materials
    3. Advance directive discussions at start of enrollment/ intake processes
    4. Advance directive discussions during clinical re-assessment visits
    5. Increased telephone follow-up initiatives

    Some improvement in advance directive procurement rates have been observed with these interventions. IPRO recommends continued efforts in these areas and recommended advance directives as a PIP topic option for the 2015 year. Language and culture-specific interventions, wherever possible and applicable, would appear to be a key to this undertaking.
  5. The percentage of respondents indicating that they had same day urgent access to providers, while improved over the 2013 results, continues to be low. The highest percentage was reported for PCPs (50%), with same day urgent access for foot doctors, eye care, audiology, and dentists notably lower (Table B4).

    IPRO continues to note that outpatient services are not in the benefit package of the partially capitated plans. However, all plans may wish to investigate access issues through possibly interviewing providers to determine exactly how urgent visits are handled. Plans may also choose to interview samples of members to obtain time intervals for urgent appointments, in order to provide outreach to certain providers.
  6. The percentage of respondents indicating that family members or caregivers are involved in care planning, while improved over 2013 results, still appear to indicate room for improvement (Table B1, 64%).

    Family involvement is the member´s choice; therefore, plans should investigate whether members would like additional family and/or caregiver participation in care planning. Plans may need to possibly consider doing more to foster member and caregiver involvement in care planning, either through care manager education (e.g. in-service training) or through outreach to vendors involved in care planning. An initial step might be a survey to a sample of members addressing whether these members would like to see family members involved in care planning or service determination discussions, and if members want family members/caregivers to receive copies of their care plans. These surveys should also address if members and / or caregivers are not satisfied with their care plans because they do not include all of the relevant issues that they perceive to be important.
  7. There were some observed race/ethnicity differences with some ratings. White respondents were more likely to report that their family members or caregivers were always/usually involved in making decisions about health care and were more likely to report always/usually receiving helpful, timely and courteous service when calling the plan. White respondents were also more likely to rate their quality of care as good/excellent, and were more likely to rate that they were always/usually able to get a regular appointment with their doctors as soon as they thought they needed one. Rates were consistently higher than black respondents, and often higher than Asian respondents. A significantly lower rate of Asian respondents reported having advance directives in place than all other respondents. Also, a significantly higher percentage of English-speaking respondents reported having these documents in place, as compared to non-English speaking respondents (Tables B9, B12).

    These results may indicate that cultural barriers associated with race, and language barriers, may be playing a role in not being satisfied with certain services and with timely access to them.

    This may be another area for plans to explore, if there is limited access to services across certain ethnic groups.
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Appendix A. Frequency Tables

Table A1: MLTC Plan Evaluation
  All Respondents Partial Cap 2013 Partial CAP 2015 PACE 2013 PACE 2015 MAP 2013 MAP 2015 Statewide 2013 Statewide 2015
Item Description N % N % N % N % N % N % N % N %
Section 1: MLTC Plan Evaluation
1a++ Our records indicate that you are a member of [HEALTH PLAN]. Is this correct?
        Yes     2,965 96     542 98     632 98     4,139 97
        No     112 4     9 2     16 2     137 3
     TOTAL     3,077       551       648       4,276  
2a Where do you live?
        At home 1,574 98 2,964 98 389 91 493 93 396 98 637 99 2,359 97 4,094 97
        Nursing home 31 2 68 2 39 9 37 7 7 2 8 1 77 3 113 3
     TOTAL 1,605   3,032   428   530   403   645   2,436   4,207  
3 MLTC plan explains services clearly?
        Always 825 53 1,507 56 201 48 222 51 202 52 353 60 1,228 52 2,082 56
        Usually 448 29 823 30 152 37 150 34 97 25 155 26 697 29 1,128 30
        Sometimes 236 15 318 12 50 12 56 13 73 19 70 12 359 15 444 12
        Never 57 4 61 2 12 3 10 2 15 4 13 2 84 4 84 2
     TOTAL 1,566   2,709   415   438   387   591   2,368   3,738  
        Don´t know or not sure 67   134   14   31   20   28   101   193  
4 Are you involved in making decisions about plan of care?
        Always 719 47 1,394 52 188 46 207 46 199 51 321 54 1,106 47 1,922 52
        Usually 382 25 659 25 124 30 144 32 79 20 127 21 585 25 930 25
        Sometimes 269 17 392 15 70 17 64 14 70 18 95 16 409 17 551 15
        Never 169 11 223 8 30 7 33 7 39 10 51 9 238 10 307 8
     TOTAL 1,539   2,668   412   448   387   594   2,338   3,710  
        Don´t know or not sure 87   168   21   25   20   26   128   219  
5 Is your family/caregiver involved in making decisions about plan of care?
        Always 642 41 1,247 46 199 48 226 48 180 46 308 51 1,021 43 1,781 47
        Usually 255 16 478 18 91 22 101 22 58 15 70 12 404 17 649 17
        Sometimes 300 19 494 18 68 16 77 16 74 19 108 18 442 19 679 18
        Never 356 23 467 17 55 13 65 14 82 21 117 19 493 21 649 17
     TOTAL 1,553   2,686   413   469   394   603   2,360   3,758  
        Don´t know or not sure 72   142   21   10   12   17   105   169  
6 Called the plan for help or a complaint/grievance?
        Yes 526 33 1,312 47 180 42 246 54 182 46 290 48 888 37 1,848 48
        No 1066 67 1,451 53 250 58 211 46 217 54 315 52 1,533 63 1,977 52
     TOTAL 1,592   2,763   430   457   399   605   2,421   3,825  
7 ♦⌃ Speak with a person quickly?
        Always 485 50 479 38 143 54 80 33 120 42 92 32 748 49 651 36
        Usually     482 38     108 45     93 33     683 38
        Sometimes 423 44 255 20 117 44 50 21 148 52 82 29 688 45 387 22
        Never 63 6 57 4 7 3 3 1 19 7 19 7 89 6 79 4
     TOTAL 971   1,273   267   241   287   286   1,525   1,800  
        Don´t know or not sure     11       0       0       11  
8 ♦⌃ Were questions answered quickly?
        Always 537 55 501 39 136 51 80 33 137 48 100 35 810 53 681 38
        Usually     470 37     99 41     97 34     666 37
        Sometimes 403 41 246 19 121 45 56 23 136 47 74 26 660 43 376 21
        Never 43 4 60 5 10 4 5 2 15 5 13 5 68 4 78 4
     TOTAL 983   1,277   267   240   288   284   1,538   1,801  
        Don´t know or not sure     11       1       3       15  
9 ♦⌃ Were you able to understand the answers?
        Always 617 63 664 52 167 63 114 48 148 52 122 43 932 61 900 50
        Usually     379 30     92 38     92 32     563 31
        Sometimes 347 35 202 16 97 36 29 12 127 45 64 22 571 37 295 16
        Never 15 2 20 2 3 1 5 2 10 4 8 3 28 2 33 2
     TOTAL 979   1,265   267   240   285   286   1,53   1,791  
        Don´t know or not sure     18       2       1       21  
10 ♦⌃ Were you treated with politeness and respect?
        Always 830 85 919 72 225 83 164 68 232 81 200 70 1,287 84 1,283 71
        Usually     274 21     58 24     55 19     387 21
        Sometimes 135 14 75 6 43 16 17 7 51 18 28 10 229 15 120 7
        Never 17 2 16 1 2 1 1 0 2 1 2 1 21 1 19 1
     TOTAL 982   1,284   270   240   285   285   1,537   1,809  
        Don´t know or not sure     2       2       2       6  
11 ♦⌃ Complaint or grievance handled to satisfaction?
        Always     378 39     58 31     75 33     511 37
        Usually     292 30     72 38     70 31     434 31
        Sometimes     205 21     48 25     63 28     316 23
        Never     104 11     12 6     20 9     136 10
     TOTAL     979       190       228       1,397  
        I did not call the plan with a complaint     307       53       53       413  
12 Has asked to see all of the prescriptions/over the counter medicines?
        Yes 1256 87 2,520 94 336 88 397 92 349 93 566 95 1,941 88 3,483 94
        No 183 13 157 6 45 12 35 8 28 7 27 5 256 12 219 6
     TOTAL 1,439   2,677   381   432   377   593   2,197   3,702  
        Don´t know or not sure 176   174   46   41   29   26   251   241  
13++ Explain the CDPA option?
        Yes     1,413 77     156 58     292 74     1,861 75
        No     418 23     111 42     105 26     634 25
     TOTAL     1,831       267       397       2,495  
        Don´t know or not sure     1,002       201       211       1,414  
14a^ Take meds the way your doctor wants you to
        Excellent 706 54 1,114 51 220 56 236 55 179 53 273 53 1,105 54 1,623 52
        Good 424 32 817 37 140 36 156 36 106 32 185 36 670 33 1,158 37
        Fair 131 10 189 9 25 6 28 7 36 11 36 7 192 9 253 8
        Poor 54 4 74 3 9 2 10 2 14 4 20 4 77 4 104 3
     TOTAL 1,315   2,194   394   430   335   514   2,044   3,138  
        Not Applicable 145   529   26   38   42   85   213   652  
14b^ Manage your illness
        Excellent 570 46 913 44 204 53 205 50 157 48 239 47 931 48 1,357 46
        Good 462 37 823 40 140 37 167 40 108 33 197 39 710 36 1,187 40
        Fair 149 12 236 11 30 8 32 8 45 14 47 9 224 11 315 11
        Poor 68 5 89 4 8 2 10 2 17 5 23 5 93 5 122 4
     TOTAL 1,249   2,061   382   414   327   506   1,958   2,981  
        Not Applicable 216   604   37   48   50   88   303   740  
14c^ Help when feeling sad and lonely
        Excellent 421 38 653 36 126 37 115 33 91 33 133 33 638 37 901 35
        Good 394 35 655 36 134 40 139 39 87 32 153 38 615 36 947 37
        Fair 199 18 320 18 57 17 66 19 54 20 70 17 310 18 456 18
        Poor 106 9 168 9 21 6 32 9 41 15 45 11 168 10 245 10
     TOTAL 1,120   1,796   338   352   273   401   1,731   2,549  
        Not Applicable 329   848   79   109   97   189   505   1,146  
14d^ Allow to stay in home and not in nursing home
        Excellent 773 67 1,331 64 234 66 272 68 204 69 328 69 1,211 67 1,931 66
        Good 249 22 586 28 95 27 100 25 59 20 118 25 403 22 804 27
        Fair 76 7 109 5 13 4 17 4 17 6 16 3 106 6 142 5
        Poor 59 5 43 2 10 3 9 2 16 5 10 2 85 5 62 2
     TOTAL 1,157   2,069   352   398   296   472   1,805   2,939  
        Not Applicable 290   560   61   63   77   126   428   749  
15 How would you rate your plan?
        Excellent 671 41 1,095 41 176 41 202 45 184 46 286 48 1,031 42 1,583 42
        Good 688 42 1,230 46 193 45 189 42 159 39 253 42 1,040 42 1,672 45
        Fair 229 14 301 11 53 12 54 12 54 13 46 8 336 14 401 11
        Poor 37 2 62 2 8 2 8 2 6 1 13 2 51 2 83 2
     TOTAL 1,625   2,688   430   453   403   598   2,458   3,739  

Note: Percentages have been rounded and may not total to 100%.

♦ Items based on skip pattern
++ New question in 2015.
⌃ Questions and/or responses have changed since 2013.


Table A2: Quality of Care
  All respondents Partial Cap 2013 Partial CAP 2015 PACE 2013 PACE 2015 MAP 2013 MAP 2015 Statewide 2013 Statewide 2015
Item Description N % N % N % N % N % N % N % N %
Section 2A: Quality of Care Providers
16 Regular Doctor
        Excellent 796 54 1,424 56 200 49 228 51 216 58 319 55 1,212 54 1,971 55
        Good 506 34 907 36 165 41 171 38 115 31 208 36 786 35 1,286 36
        Fair 132 9 163 6 30 7 35 8 39 10 41 7 201 9 239 7
        Poor 33 2 49 2 10 2 12 3 5 1 15 3 48 2 76 2
     TOTAL 1,467   2,543   405   446   375   583   2,247   3,572  
        Not Applicable 72   170   16   17   13   23   101   210  
17 Dentist
        Excellent 320 32 536 32 81 28 120 36 69 30 95 25 470 31 751 32
        Good 400 40 678 41 132 45 139 41 73 32 175 47 605 40 992 42
        Fair 178 18 293 18 44 15 50 15 57 25 67 18 279 18 410 17
        Poor 111 11 162 10 34 12 28 8 31 13 39 10 176 12 229 10
     TOTAL 1,009   1,669   291   337   230   376   1,530   2,382  
        Not Applicable 430   918   123   119   133   207   686   1,244  
18 Eye Care
        Excellent 527 41 906 42 141 40 160 41 146 46 231 44 814 42 1,297 42
        Good 527 41 855 39 143 40 145 37 102 32 215 41 772 40 1,215 39
        Fair 155 12 288 13 51 14 57 15 50 16 48 9 256 13 393 13
        Poor 70 5 118 5 20 6 29 7 19 6 27 5 109 6 174 6
     TOTAL 1,279   2,167   355   391   317   521   1,951   3,079  
        Not Applicable 222   500   66   71   64   79   352   650  
19 Foot Doctor
        Excellent 503 46 840 44 109 39 118 37 121 44 171 42 733 45 1,129 43
        Good 385 35 747 39 106 38 143 44 91 33 160 39 582 35 1,050 40
        Fair 127 12 217 11 45 16 42 13 28 10 54 13 200 12 313 12
        Poor 72 7 99 5 18 6 19 6 35 13 27 7 125 8 145 5
     TOTAL 1,087   1,903   278   322   275   412   1,640   2,637  
        Not Applicable 364   679   127   125   93   166   584   970  
20a Home Health Aide
        Excellent 814 60 1,361 56 161 48 187 50 204 57 314 58 1,179 57 1,862 56
        Good 382 28 762 31 125 37 127 34 104 29 150 28 611 30 1,039 31
        Fair 120 9 229 9 38 11 40 11 38 11 50 9 196 10 319 10
        Poor 42 3 85 3 13 4 19 5 15 4 27 5 70 3 131 4
     TOTAL 1,358   2,437   337   373   361   541   2,056   3,351  
        Not Applicable 141   154   78   70   14   29   233   253  
20b Home Health Agency
        Excellent 640 46 1,059 42 123 38 154 43 157 43 210 37 920 44 1,423 41
        Good 492 35 947 38 146 45 138 38 122 34 220 39 760 37 1,305 38
        Fair 189 14 354 14 39 12 50 14 60 17 111 19 288 14 515 15
        Poor 66 5 151 6 17 5 19 5 22 6 29 5 105 5 199 6
     TOTAL 1,387   2,511   325   361   361   570   2,073   3,442  
        Not Applicable 123   155   87   84   12   26   222   265  
21 Care Manager
        Excellent 675 49 1,057 43 159 43 182 44 175 50 213 39 1,009 48 1,452 42
        Good 488 35 998 40 157 43 168 41 122 35 232 42 767 36 1,398 41
        Fair 164 12 303 12 36 10 44 11 43 12 69 13 243 12 416 12
        Poor 62 4 121 5 14 4 20 5 13 4 38 7 89 4 179 5
     TOTAL 1,389   2,479   366   414   353   552   2,108   3,445  
        Not Applicable 115   173   45   37   18   37   178   247  
22a Regular Visiting Nurse
        Excellent 716 50 1,058 44 194 54 207 52 157 45 226 42 1,067 50 1,491 44
        Good 477 34 949 39 120 33 144 36 121 34 215 40 718 34 1,308 39
        Fair 167 12 292 12 34 9 35 9 43 12 62 11 244 11 389 12
        Poor 60 4 113 5 12 3 15 4 31 9 39 7 103 5 167 5
     TOTAL 1,420   2,412   360   401   352   542   2,132   3,355  
        Not Applicable 112   286   56   63   25   54   193   403  
22b Covering/On Call Nurse
        Excellent 340 36 543 35 107 38 121 38 76 33 129 37 523 36 793 36
        Good 386 41 651 42 128 45 148 46 79 34 137 39 593 41 936 42
        Fair 140 15 247 16 37 13 43 13 43 19 50 14 220 15 340 15
        Poor 76 8 118 8 12 4 10 3 32 14 36 10 120 8 164 7
     TOTAL 942   1,559   284   322   230   352   1,456   2,233  
        Not Applicable 483   1,017   110   135   129   218   722   1,370  
23 Physical Therapist
        Excellent 267 38 401 36 113 45 128 43 47 30 64 30 427 39 593 37
        Good 254 37 451 41 98 39 120 41 50 32 88 42 402 37 659 41
        Fair 95 14 156 14 30 12 31 11 29 19 37 17 154 14 224 14
        Poor 78 11 105 9 9 4 16 5 29 19 23 11 116 11 144 9
     TOTAL 694   1,113   250   295   155   212   1,099   1,620  
        Not Applicable 731   1,413   159   157   214   355   1,104   1,925  
24 Occupational Therapist
        Excellent 121 31 226 36 78 42 94 43 23 25 40 31 222 33 360 37
        Good 152 39 231 37 66 36 94 43 25 27 57 45 243 36 382 39
        Fair 50 13 95 15 28 15 18 8 16 18 17 13 94 14 130 13
        Poor 68 17 79 13 12 7 15 7 27 30 13 10 107 16 107 11
     TOTAL 391   631   184   221   91   127   666   979  
        Not Applicable 980   1,811   220   222   264   423   1,464   2,456  
25 Speech Therapist
        Excellent 51 24 130 40 20 31 33 49 10 21 21 36 81 25 184 41
        Good 72 33 97 30 20 31 20 29 9 19 22 37 101 31 139 31
        Fair 35 16 53 16 11 17 8 12 5 10 7 12 51 16 68 15
        Poor 57 27 44 14 14 22 7 10 24 50 9 15 95 29 60 13
     TOTAL 215   324   65   68   48   59   328   451  
        Not Applicable 1,135   2,072   332   364   301   485   1,768   2,921  
26 Social Worker
        Excellent 356 40 535 38 183 50 185 48 85 37 99 32 624 42 819 39
        Good 310 35 543 39 114 31 135 35 82 36 127 41 506 34 805 38
        Fair 146 16 203 14 46 13 54 14 32 14 48 16 224 15 305 15
        Poor 81 9 125 9 21 6 11 3 30 13 35 11 132 9 171 8
     TOTAL 893   1,406   364   385   229   309   1,486   2,100  
        Not Applicable 516   1,112   48   71   135   245   699   1,428  
27 Medical Supplies and Equipment
        Excellent 592 50 873 42 183 52 195 49 146 48 209 44 921 50 1,277 43
        Good 418 35 810 39 143 40 154 39 103 34 170 36 664 36 1,134 39
        Fair 122 10 257 12 20 6 33 8 38 13 67 14 180 10 357 12
        Poor 53 4 126 6 9 3 18 5 17 6 25 5 79 4 169 6
     TOTAL 1,185   2,066   355   400   304   471   1,844   2,937  
        Not Applicable 273   550   56   57   67   109   396   716  
28 Audiology / Hearing Aids
        Excellent 115 33 185 32 46 37 60 39 21 26 46 33 182 33 291 34
        Good 110 31 197 34 49 39 48 31 21 26 53 38 180 32 298 34
        Fair 63 18 106 18 16 13 24 16 12 15 24 17 91 16 154 18
        Poor 62 18 85 15 15 12 22 14 28 34 16 12 105 19 123 14
     TOTAL 350   573   126   154   82   139   558   866  
        Not Applicable 1,030   1,886   275   287   274   414   1,579   2,587  
29 Home Delivered Meals / Meals on Wheels
        Excellent 110 40 197 47 35 48 35 44 19 32 38 55 164 40 270 48
        Good 66 24 120 29 21 29 27 34 17 29 17 25 104 26 164 29
        Fair 27 10 60 14 11 15 13 16 7 12 3 4 45 11 76 13
        Poor 71 26 38 9 6 8 4 5 16 27 11 16 93 23 53 9
     TOTAL 274   415   73   79   59   69   406   563  
        Not Applicable 1,093   2,033   328   353   295   481   1,716   2,867  
30 Meals served at Day Health Center
        Excellent 112 36 234 39 116 39 114 33 15 25 40 52 243 36 388 38
        Good 90 29 221 37 123 41 163 47 17 28 19 25 230 34 403 40
        Fair 51 16 87 15 46 15 53 15 8 13 12 16 105 16 152 15
        Poor 60 19 51 9 14 5 14 4 21 34 6 8 95 14 71 7
     TOTAL 313   593   299   344   61   77   673   1,014  
        Not Applicable 1,069   1,875   110   114   293   469   1,472   2,458  
31 Day Health Center Activities
        Excellent 132 37 282 43 123 40 115 33 22 33 45 48 277 38 442 40
        Good 125 35 250 38 132 43 154 44 15 22 28 30 272 37 432 39
        Fair 41 11 96 15 36 12 61 17 10 15 14 15 87 12 171 16
        Poor 60 17 31 5 19 6 20 6 20 30 6 6 99 13 57 5
     TOTAL 358   659   310   350   67   93   735   1,102  
        Not Applicable 1,028   1,798   99   110   288   456   1,415   2,364  
32 Transportation Services
        Excellent 534 43 765 38 186 48 187 44 93 32 158 37 813 42 1,110 39
        Good 424 34 764 38 147 38 178 42 105 37 151 35 676 35 1,093 38
        Fair 167 13 312 16 40 10 41 10 49 17 72 17 256 13 425 15
        Poor 117 9 159 8 14 4 15 4 40 14 51 12 171 9 225 8
     TOTAL 1,242   2,000   387   421   287   432   1,916   2,853  
        Not Applicable 246   649   31   41   88   148   365   838  
33 Nursing Home
        Excellent 62 34 119 41 31 46 23 44 7 18 22 61 100 35 164 44
        Good 53 29 101 35 21 31 15 29 9 23 9 25 83 29 125 33
        Fair 23 13 45 16 7 10 10 19 4 10 3 8 34 12 58 15
        Poor 43 24 24 8 9 13 4 8 20 50 2 6 72 25 30 8
     TOTAL 181   289   68   52   40   36   289   377  
        Not Applicable 1,167   2,095   324   373   306   502   1,797   2,970  
34 Pharmacy Services
        Excellent 753 57 1,160 51 201 52 194 46 180 55 267 49 1,134 56 1,621 50
        Good 434 33 924 41 152 39 196 46 110 33 204 37 696 34 1,324 41
        Fair 90 7 153 7 24 6 28 7 33 10 57 10 147 7 238 7
        Poor 41 3 44 2 10 3 5 1 7 2 20 4 58 3 69 2
     TOTAL 1,318   2,281   387   423   330   548   2,035   3,252  
        Not Applicable 181   388   30   32   48   48   259   468  
35 Nutritionist
        Excellent 170 36 211 33 110 39 108 34 28 27 50 34 308 36 369 33
        Good 173 37 254 40 130 46 157 50 40 38 60 41 343 40 471 43
        Fair 63 13 108 17 32 11 39 12 14 13 17 12 109 13 164 15
        Poor 62 13 69 11 10 4 10 3 23 22 19 13 95 11 98 9
     TOTAL 468   642   282   314   105   146   855   1,102  
        Not Applicable 925   1,820   123   137   253   407   1,301   2,364  

Note: Percentages have been rounded and may not total to 100%.


Table A3: Timeliness of Care
  All respondents Partial Cap 2013 Partial CAP 2015 PACE 2013 PACE 2015 MAP 2013 MAP 2015 Statewide 2013 Statewide 2015
Item Description N % N % N % N % N % N % N % N %
Section 2B: Timeliness
36 Home Health Aide
Always 757 60 1,781 72 140 44 229 61 204 64 403 75 1,101 58 2,413 71
Usually 233 19 501 20 106 33 108 29 45 14 109 20 384 20 718 21
Sometimes 147 12 147 6 55 17 31 8 33 10 20 4 235 12 198 6
Never 121 10 42 2 18 6 6 2 38 12 8 1 177 9 56 2
     TOTAL 1,258   2,471   319   374   320   540   1,897   3,385  
        Not Applicable 209   185   87   73   47   41   343   299  
37 Care Manager / Case Manager
Always 545 44 1,149 51 136 40 200 53 146 47 241 49 827 44 1,590 51
Usually 314 26 728 32 96 28 127 33 62 20 160 32 472 25 1,015 32
Sometimes 221 18 289 13 78 23 38 10 57 18 66 13 356 19 393 13
Never 145 12 104 5 31 9 15 4 45 15 27 5 221 12 146 5
     TOTAL 1,225   2,270   341   380   310   494   1,876   3,144  
        Not Applicable 214   324   64   63   56   72   334   459  
38a Regular Visiting Nurse
Always 635 47 1,168 51 157 46 227 62 151 45 236 46 943 47 1,631 51
Usually 309 23 699 30 85 25 89 24 65 19 163 32 459 23 951 30
Sometimes 271 20 336 15 64 19 41 11 80 24 93 18 415 20 470 15
Never 136 10 94 4 34 10 11 3 40 12 20 4 210 10 125 4
     TOTAL 1,351   2,297   340   368   336   512   2,027   3,177  
        Not Applicable 141   360   74   80   38   69   253   509  
38b Covering/On Call Nurse
Always 357 40 643 44 112 38 145 48 83 36 136 41 552 39 924 44
Usually 222 25 431 30 93 31 99 33 44 19 106 32 359 25 636 30
Sometimes 194 22 250 17 58 19 42 14 50 21 52 16 302 21 344 16
Never 126 14 135 9 35 12 15 5 56 24 38 11 217 15 188 9
     TOTAL 899   1,459   298   301   233   332   1,430   2,092  
        Not Applicable 528   1,080   117   148   130   227   775   1,455  
39 Physical Therapist
Always 194 34 368 43 89 43 120 49 33 29 64 38 316 36 552 43
Usually 115 20 268 31 49 24 77 31 21 18 43 25 185 21 388 31
Sometimes 135 24 114 13 36 18 31 13 24 21 27 16 195 22 172 14
Never 119 21 106 12 31 15 17 7 37 32 35 21 187 21 158 12
     TOTAL 563   856   205   245   115   169   883   1,270  
        Not Applicable 828   1,629   202   198   238   376   1,268   2,203  
40 Occupational Therapist
Always 93 28 205 41 70 50 92 52 18 23 40 39 181 33 337 43
Usually 74 22 128 26 30 21 55 31 13 16 21 21 117 21 204 26
Sometimes 63 19 72 14 20 14 19 11 9 11 9 9 92 17 100 13
Never 100 30 92 19 21 15 12 7 39 49 32 31 160 29 136 18
     TOTAL 330   497   141   178   79   102   550   777  
        Not Applicable 1,042   1,934   263   262   266   423   1,571   2,619  
41 Speech Therapist
Always 59 26 113 40 23 40 30 50 15 26 18 30 97 28 161 40
Usually 54 24 61 21 11 19 13 22 5 9 8 13 70 21 82 20
Sometimes 26 11 37 13 8 14 5 8 6 11 5 8 40 12 47 12
Never 88 39 74 26 15 26 12 20 31 54 30 49 134 39 116 29
     TOTAL 227   285   57   60   57   61   341   406  
        Not Applicable 1,127   2,134   344   373   291   459   1,762   2,966  
42 Social Worker
Always 281 35 507 43 161 50 192 56 51 28 109 41 493 38 808 45
Usually 156 20 352 30 59 18 86 25 31 17 75 28 246 19 513 28
Sometimes 204 26 211 18 64 20 45 13 54 30 47 18 322 25 303 17
Never 154 19 121 10 40 12 22 6 47 26 35 13 241 19 178 10
     TOTAL 795   1,191   324   345   183   266   1,302   1,802  
        Not Applicable 608   1,256   82   97   161   265   851   1,618  
43 Home Delivered Meals / Meals on Wheels
Always 129 42 206 48 44 56 53 62 27 39 31 38 200 44 290 49
Usually 57 19 99 23 10 13 18 21 8 11 17 21 75 17 134 22
Sometimes 28 9 45 10 8 10 3 3 6 9 5 6 42 9 53 9
Never 92 30 80 19 16 21 12 14 29 41 28 35 137 30 120 20
     TOTAL 306   430   78   86   70   81   454   597  
        Not Applicable 1,065   1,985   327   345   281   442   1,673   2,772  
44a Transportation TO Day Center
Always 189 43 387 57 148 49 200 61 42 41 57 56 379 45 644 58
Usually 82 19 176 26 62 20 96 29 12 12 21 21 156 18 293 26
Sometimes 68 15 59 9 55 18 24 7 15 15 10 10 138 16 93 8
Never 100 23 59 9 39 13 8 2 33 32 13 13 172 20 80 7
     TOTAL 439   681   304   328   102   101   845   1,110  
        Not Applicable 932   1,450   105   120   250   354   1,287   1,924  
44b Transportation FROM Day Center
Always 156 44 341 55 144 48 183 59 32 40 44 52 332 45 568 56
Usually 74 21 161 26 71 23 95 31 6 7 16 19 151 20 272 27
Sometimes 43 12 62 10 48 16 19 6 11 14 9 11 102 14 90 9
Never 85 24 52 8 40 13 13 4 32 40 15 18 157 21 80 8
     TOTAL 358   616   303   310   81   84   742   1,010  
        Not Applicable 972   1,446   107   122   258   357   1,337   1,925  
44c Transportation TO the doctor
Always 536 47 953 54 180 49 225 61 114 46 198 52 830 47 1,376 55
Usually 246 21 467 26 83 22 109 29 51 20 88 23 380 22 664 26
Sometimes 230 20 237 13 73 20 32 9 41 16 64 17 344 19 333 13
Never 135 12 106 6 34 9 4 1 43 17 32 8 212 12 142 6
     TOTAL 1,147   1,763   370   370   249   382   1,766   2,515  
        Not Applicable 306   721   47   66   102   155   455   942  
44d Transportation FROM the doctor
Always 518 46 908 52 170 46 208 56 112 44 191 50 800 46 1,307 52
Usually 239 21 454 26 80 22 103 28 47 19 87 23 366 21 644 26
Sometimes 235 21 261 15 81 22 48 13 46 18 72 19 362 21 381 15
Never 132 12 130 7 35 10 11 3 47 19 32 8 214 12 173 7
     TOTAL 1,124   1,753   366   370   252   382   1,742   2,505  
        Not Applicable 290   725   47   66   99   153   436   944  
45 Medical Supplies and Equipment
Always 486 46 982 53 157 46 219 57 128 53 247 58 771 47 1,448 54
Usually 243 23 551 30 85 25 117 30 45 19 114 27 373 23 782 29
Sometimes 200 19 220 12 63 18 37 10 36 15 51 12 299 18 308 12
Never 130 12 108 6 40 12 14 4 34 14 14 3 204 12 136 5
     TOTAL 1,059   1,861   345   387   243   426   1,647   2,674  
        Not Applicable 336   613   63   60   101   122   500   795  
46 Pharmacy Services
Always 713 57 1,429 65 201 53 255 61 192 65 332 65 1,106 57 2,016 64
Usually 257 21 617 28 83 22 136 32 39 13 128 25 379 20 881 28
Sometimes 126 10 110 5 52 14 19 5 28 9 35 7 206 11 164 5
Never 154 12 46 2 44 12 9 2 37 13 14 3 235 12 69 2
     TOTAL 1,250   2,202   380   419   296   509   1,926   3,130  
        Not Applicable 213   416   32   35   66   58   311   509  
47 Audiology/Hearing Aids
Always 117 35 191 39 44 36 66 50 27 39 43 39 188 36 300 41
Usually 76 23 150 30 35 29 37 28 8 11 29 26 119 23 216 29
Sometimes 64 19 66 13 24 20 10 8 10 14 14 13 98 19 90 12
Never 76 23 88 18 19 16 18 14 25 36 25 23 120 23 131 18
     TOTAL 333   495   122   131   70   111   525   737  
        Not Applicable 1,040   1,951   279   307   275   413   1,594   2,671  

Note: Percentages have been rounded and may not total to 100%.


Table A4: Access to Care (Urgent Appointments)
  All respondents Partial Cap 2013 Partial CAP 2015 PACE 2013 PACE 2015 MAP 2013 MAP 2015 Statewide 2013 Statewide 2015
Item Description N % N % N % N % N % N % N % N %
Section 2C: Access to Care - Urgent Appointment
48 Regular Doctor
Same day 522 46 1,033 50 157 48 185 50 118 38 224 49 797 45 1,442 50
1 to 3 days 389 35 695 34 129 40 140 38 111 36 140 30 629 36 975 34
4 days or longer 213 19 329 16 38 12 43 12 78 25 96 21 329 19 468 16
     TOTAL 1,124   2,057   324   368   307   460   1,755   2,885  
        Not Applicable 374   575   92   84   66   114   532   773  
49 Dentist
Same day 173 28 324 31 25 14 45 20 39 29 78 32 237 26 447 29
1 to 3 days 214 35 439 41 77 45 81 37 41 30 83 34 332 36 603 40
4 days or longer 225 37 299 28 71 41 95 43 55 41 82 34 351 38 476 31
     TOTAL 612   1,062   173   221   135   243   920   1,526  
        Not Applicable 796   1,449   230   228   213   310   1,239   1,987  
50 Eye Care
Same day 196 25 502 34 26 13 76 27 44 21 129 33 266 22 707 33
1 to 3 days 260 33 546 36 70 35 92 33 62 30 143 37 392 33 781 36
4 days or longer 332 42 449 30 104 52 110 40 101 49 118 30 537 45 677 31
     TOTAL 788   1,497   200   278   207   390   1,195   2,165  
        Not Applicable 664   1,057   207   173   159   183   1,030   1,413  
51 Foot Doctor
Same day 185 27 476 35 37 23 71 30 45 24 99 32 267 26 646 34
1 to 3 days 242 35 525 38 44 27 82 35 58 32 110 36 344 33 717 38
4 days or longer 265 38 367 27 82 50 82 35 81 44 100 32 428 41 549 29
     TOTAL 692   1,368   163   235   184   309   1,039   1,912  
        Not Applicable 732   1,192   245   217   179   247   1,156   1,656  
52 Audiology/Hearing Aids
Same day 78 33 128 34 15 19 32 30 18 35 31 28 111 30 191 32
1 to 3 days 69 29 118 31 24 31 31 30 12 23 41 37 105 29 190 32
4 days or longer 90 38 132 35 38 49 42 40 22 42 38 35 150 41 212 36
     TOTAL 237   378   77   105   52   110   366   593  
        Not Applicable 1,150   2,048   324   337   299   428   1,773   2,813  

Note: Percentages have been rounded and may not total to 100%.


Table A5: Access to Care (Regular Appointments)
  All respondents Partial Cap 2013 Partial CAP 2015 PACE 2013 PACE 2015 MAP 2013 MAP 2015 Statewide 2013 Statewide 2015
Item Description N % N % N % N % N % N % N % N %
Section 2D: Access to Care - Regular Appointment
53 Regular Doctor
        Always     1,518 63     203 53     339 64     2,060 62
        Usually     618 26     126 33     119 22     863 26
        Sometimes     209 9     41 11     56 11     306 9
        Never     67 3     13 3     19 4     99 3
     TOTAL 1,403   2,412   343   383   358   533   2,104   3,328  
        Not Applicable 131   245   74   75   21   48   226   368  
54^ Dentist
        Always     558 42     93 37     113 38     764 41
        Usually     438 33     85 34     85 29     608 32
        Sometimes     221 17     51 20     65 22     337 18
        Never     106 8     24 9     34 11     164 9
     TOTAL 832   1,323   229   253   173   297   1,234   1,873  
        Not Applicable 611   1,195   186   194   183   272   980   1,661  
55^ Eye Care
        Always     826 47     116 39     203 48     1,145 46
        Usually     580 33     107 36     129 31     816 33
        Sometimes     266 15     62 21     69 16     397 16
        Never     95 5     15 5     18 4     128 5
     TOTAL 1,093   1,767   282   300   272   419   1,647   2,486  
        Not Applicable 379   806   133   151   101   155   613   1,112  
56^ Foot Doctor
        Always     814 51     102 40     171 48     1,087 49
        Usually     505 31     85 33     100 28     690 31
        Sometimes     198 12     48 19     59 17     305 14
        Never     91 6     20 8     27 8     138 6
     TOTAL 932   1,608   223   255   235   357   1,390   2,220  
        Not Applicable 524   979   192   194   134   209   850   1,382  
57^ Audiology/Hearing Aids
        Always     201 41     42 35     44 38     287 40
        Usually     135 28     38 31     33 28     206 28
        Sometimes     74 15     22 18     14 12     110 15
        Never     76 16     19 16     25 22     120 17
     TOTAL 289   486   113   121   59   116   461   723  
        Not Applicable 1,098   1,979   288   317   292   425   1,678   2,721  

Note: Percentages have been rounded and may not total to 100%.
^ Questions and/or responses have changed since 2013.


Table A6: About You
  All respondents Partial Cap 2013 Partial CAP 2015 PACE 2013 PACE 2015 MAP 2013 MAP 2015 Statewide 2013 Statewide 2015
Item Description N % N % N % N % N % N % N % N %
Section 3: About You
58 Content with Quality of Life
Quite a bit 502 32 934 30 146 34 166 30 95 24 135 20 743 31 1,235 28
Somewhat 410 26 755 24 101 23 134 24 110 28 163 24 621 26 1,052 24
A little bit 142 9 325 10 43 10 28 5 40 10 68 10 225 9 421 10
        Not At all 84 5 141 4 18 4 21 4 28 7 33 5 130 5 195 4
     TOTAL 1,585   3,147   433   556   400   675   2,418   4,378  
59 Rate your current state of health
        Excellent     122 4     24 4     39 6     185 4
        Very good 84 6 287 9 37 9 116 21 23 6 92 13 144 6 495 11
        Good 384 25 776 24 157 37 178 32 97 26 149 22 638 27 1,103 25
        Fair 725 48 1,515 48 166 39 176 32 174 46 317 46 1,065 46 2,008 46
        Poor 325 21 474 15 66 15 61 11 85 22 87 13 476 20 622 14
     TOTAL 1,518   3,174   426   555   379   684   2,323   4,413  
60++ Rating of overall mental/emotional health
        Excellent     283 9     59 11     73 11     415 9
        Very Good     421 13     109 20     108 16     638 14
        Good     930 29     187 34     207 30     1,324 30
        Fair     1,217 38     159 29     230 34     1,606 36
        Poor     323 10     40 7     68 10     431 10
     TOTAL     3,174       554       686       4,414  
61 What is your gender?
Male 423 26 848 27 108 25 144 26 78 19 130 19 609 25 1,122 26
Female 1,181 74 2,310 73 328 75 410 74 326 81 558 81 1,835 75 3,278 75
     TOTAL 1,604   3,158   436   554   404   688   2,444   4,400  
62 What is your age?
18-44 44 3 50 2 0 0 1 0 9 2 8 1 53 2 59 1
45-64 292 18 432 14 21 5 45 8 70 17 85 12 383 16 562 13
65-74 333 21 692 22 86 20 131 24 80 20 144 21 499 20 967 22
75-84 511 31 1,045 33 154 35 171 31 140 34 233 34 805 33 1,449 33
over 85 443 27 969 30 177 40 207 37 110 27 218 32 730 30 1,394 31
     TOTAL 1,623   3,188   438   555   409   688   2,470   4,431  
63a Are you Hispanic/Latino origin?
        Yes 498 32 772 25 65 15 91 17 132 35 293 44 695 29 1,156 27
        No 1,058 68 2,321 75 358 85 456 83 250 65 379 56 1,666 71 3,156 73
     TOTAL 1,556   3,093   423   547   382   672   2,361   4,312  
63b+ What is your race?
American Indian or Alaskan Native 25 2 56 2 6 1 11 2 8 2 16 3 39 2 83 2
Asian 283 21 525 19 65 16 53 10 20 6 43 9 368 17 621 17
Black or African American 303 22 639 24 69 17 95 19 157 46 250 50 529 25 984 26
Native Hawaiian or Pacific Islander 5 0 10 0 0 0 1 0 2 1 2 0 7 0 13 0
White 661 49 1,482 55 264 64 353 69 127 37 192 38 1,052 50 2,027 54
Other 73 5 4 0 10 2 0 0 28 8 1 0 111 5 5 0
     TOTAL 1,350   2,716   414   513   342   504   2,106   3,733  
64++ How well do you speak English?
        Very well     1,200 38     359 65     312 46     1,871 43
        Well     392 12     76 14     108 16     576 13
        Not well     692 22     56 10     138 20     886 20
        Not At all     876 28     62 11     122 18     1,060 24
     TOTAL     3,160       553       680       4,393  
65 Primary language spoken at home
        English 698 43 1,729 52 308 70 450 78 262 65 417 59 1,268 51 2,596 57
        Spanish 411 25 520 16 52 12 54 9 110 27 232 33 573 23 806 18
        Russian 188 12 472 14 14 3 9 2 5 1 6 1 207 8 487 11
        Chinese 239 15 371 11 56 13 34 6 11 3 15 2 306 12 420 9
        Other 84 5 214 6 11 2 27 5 15 4 42 6 110 4 283 6
     TOTAL 1,620   3,306   441   574   403   712   2,464   4,592  
66 Education level completed
        8th grade or less 537 34 982 32 136 32 135 25 152 38 273 41 825 34 1,390 32
        Some high school, did not graduate 262 17 471 15 67 16 68 13 94 24 141 21 423 18 680 16
        High school graduate or GED 334 21 703 23 117 27 148 28 86 22 134 20 537 22 985 23
        Some college or 2 year degree 196 13 391 13 47 11 76 14 46 12 82 12 289 12 549 13
        4 year college graduate 147 9 288 9 31 7 55 10 14 4 19 3 192 8 362 8
        More than 4 year college degree 92 6 261 8 32 7 53 10 7 2 19 3 131 5 333 8
     TOTAL 1,568   3,096   430   535   399   668   2,397   4,299  
67 Do you live
        Alone 728 48 1,471 46 197 52 255 47 192 50 370 53 1,117 49 2,096 48
        With a family member or friend 709 47 1,514 48 141 37 212 39 174 46 295 43 1,024 45 2,021 46
        With other than a family member or friend 86 6 185 6 41 11 74 14 16 4 27 4 143 6 286 6
     TOTAL 1,523   3,170   379   541   382   692   2,284   4,403  
68 Did someone help you complete this survey
        Yes 1,001 63 1,985 64 309 71 389 71 274 69 468 70 1,584 65 2,842 65
        No 592 37 1,132 36 127 29 161 29 122 31 205 30 841 35 1,498 35
     TOTAL 1,593   3,117   436   550   396   673   2,425   4,340  
69 ♦ + Who helped you
        Family member 564 56 1,295 65 189 61 234 60 173 63 321 69 926 58 1,850 65
        Friend 86 9 185 9 33 11 46 12 21 8 24 5 140 9 255 9
        Home Care Aide 217 22 344 17 18 6 33 8 62 23 107 23 297 19 484 17
        Care Manager or Visiting Nurse 35 3 69 3 10 3 29 7 2 1 12 3 47 3 110 4
        Other 95 9 97 5 64 21 48 12 17 6 11 2 176 11 156 5
     TOTAL 1,001   1,985   309   389   274   468   1,584   2,842  
70 ♦ + How did this person help you
        Read the questions to me 543 54 1,090 55 185 60 219 56 167 61 288 62 895 57 1,597 56
        Wrote down the answers that I gave 423 42 897 45 144 47 194 50 123 45 189 40 690 44 1,280 45
        Answered the questions for me 241 24 515 26 104 34 134 34 58 21 105 22 403 25 754 27
        Translated into my language 137 14 328 17 25 8 24 6 31 11 64 14 193 12 416 15
        Helped in some other way 72 7 119 6 13 4 12 3 20 7 31 7 105 7 162 6
     TOTAL 1,001   1,985   309   389   274   468   1,584   2,842  
71 Has health plan talked to you about appointing someone to make decisions about your health if you are unable to do so?
        Yes 861 64 1,689 63 317 81 385 77 245 70 447 75 1,423 68 2,521 67
        No 485 36 971 37 72 19 112 23 107 30 153 26 664 32 1,236 33
     TOTAL 1,346   2,660   389   497   352   600   2,087   3,757  
        Not sure 262   471   46   54   49   80   357   605  
72 Do you have a legal document or advance directive appointing someone to make decisions about your health care if you are unable to do so?
        Yes 759 55 1,402 53 326 83 415 84 226 62 357 61 1,311 61 2,174 58
        No 628 45 1,243 47 69 17 79 16 137 38 226 39 834 39 1,548 42
     TOTAL 1,387   2,645   395   494   363   583   2,145   3,722  
        Not sure 226   459   57   65   72   101   355   625  
73 ♦ Does the health plan have a copy of this advance directive document?
        Yes 394 74 684 75 246 91 327 94 100 65 175 71 740 77 1,186 79
        No 139 26 229 25 23 9 21 6 54 35 70 29 216 23 320 21
     TOTAL 533   913   269   348   154   245   956   1,506  
        Not sure 226   459   57   65   72   101   355   625  

Note: Percentages have been rounded and may not total to 100%.
♦ Items based on skip pattern.
+ Member can check all that apply.
++ New question in 2015

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Appendix B. Aggregate Tables

Table B1: Plan Evaluation – Comparison by Survey Year
  2013 2015 2013 v. 2015
Item Description Denom* Percent Denom* Percent
Section 1: MLTC Plan Evaluation
1a++ Member of a [health plan]     4,276 97
2a Live at home/nursing home 2,436 97 4,207 97
3 Plan always/usually explained services clearly 2,368 81 3,738 86
4 Always/Usually involved in decisions about plan of care 2,338 72 3,710 77
5 Family member or caregiver always/usually involved in making decisions about plan of care 2,360 60 3,758 64
6^ Called plan with question or for help or complaint/grievance 2,442 65 3,825 48
7♦^ Always/usually spoke with a person quickly 1,525 49 1,800 74
8♦^ Questions always/usually answered quickly 1,538 53 1,801 75
9♦^ Always/usually able to understand the answers 1,531 61 1,791 81
10♦^ Always/usually treated with politeness and respect 1,537 84 1,809 92
11♦^ Complaint/grievance always/usually handled to satisfaction 2,421 37 1,397 68
  Complaint was always/usually responded to in a timely manner 840     44
  Always/usually satisfied with response 844 39    
  Always/usually treated with politeness and respect 857 74    
12 Plan asked to see prescription/over the counter medicines 2,197 88 3,702 94
13++ Health plan explain Consumer Directed Personal Assistance     2,495 75
  Plan has been excellent/good at helping me to have fewer falls 1,587 78    
14a Plan has been excellent/good at helping me to take my medications the way my doctor wants me to 2,044 87 3,138 89
14b Plan has been excellent/good at helping me to manage my illnesses 1,958 84 2,981 86
14c Plan has been excellent/good at helping me when I'm feeling sad and lonely 1,731 73 2,549 72
14d Plan has been excellent/good at helping to allow me to stay in my home 1,805 89 2,939 93
15 Rated plan as good or excellent 2,458 84 3,739 87
  Would recommend the plan 2,397 89    
71 Health plan has talked about appointing someone to make health care decisions 2,087 68 3,757 67
72 Has a legal document appointing someone to make health care decisions 2,145 61 3,722 58
73 Health plan has a copy of this legal document 956 77 1,506 79

* Denominator excludes Not Applicable responses. Total responses to each survey item varied; percentages were calculated on the number of responses for each item, and exclude Not Applicable responses.
♦ Items based on skip pattern.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.
^ Questions and/or responses have changed since 2013.


Table B2: Quality of Care – Comparison by Survey Year
  2013 2015 2013 v. 2015
Item Description Denom* Percent Denom* Percent
Section 2A: Quality of Care Providers (Excellent/Good)
16 Regular doctor 2,247 89 3,572 91
34 Pharmacy Services 2,035 90 3,252 91
20a Home Health Aide, Personal Care Aide 2,056 87 3,351 87
22a Regular Visiting Nurse/Registered Nurse 2,132 84 3,355 83
21 Care Manager/Case Manager 2,108 84 3,445 83
19 Foot Doctor 1,640 80 2,637 83
27 Medical Supplies and Equipment 1,844 86 2,937 82
18 Eye Care 1,951 82 3,079 81
31 Day Health Center Activities 735 75 1,102 79
20b Home Health Agency, Personal Care Agency 2,073 81 3,442 79
30 Meals served at the Day Health Center 673 70 1,014 78
22b Covering/On-call nurse 1,456 77 2,233 78
23 Physical Therapist 1,099 75 1,620 78
26 Social Worker 1,486 76 2,100 77
32 Transportation Services 1,916 77 2,853 77
29 Home Delivered Meals/Meals on Wheels 406 66 563 77
33 Nursing Home 289 64 377 77
35 Nutritionist 855 76 1,102 76
24 Occupational Therapist 666 69 979 76
17 Dentist 1,530 71 2,382 73
25 Speech Therapist 328 56 451 72
28 Audiology/Hearing Aids 558 65 866 68

* Denominator excludes Not Applicable responses. Total responses to each survey item varied; percentages were calculated on the number of responses for each item, and exclude Not Applicable responses.
♦ Items based on skip pattern.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B3: Timeliness of Care – Comparison by Survey Year
  2013 2015 2013 v. 2015
Item Description Denom* Percent Denom* Percent
Section 2B: Timeliness (Always/Usually)
46 Pharmacy Services 1,926 77 3,130 92
36 Home Health Aide, Personal Care Aide 1,897 78 3,385 92
44a Transportation: TO Day Center 845 63 1,110 84
45 Medical Supplies and Equipment 1,647 70 2,674 83
44b Transportation: FROM Day Center 742 65 1,010 83
37 Care Manager/Case Manager 1,876 69 3,144 83
38a Regular Visiting Nurse/Registered Nurse 2,027 70 3,177 81
44c Transportation: TO the doctor 1,766 69 2,515 81
44d Transportation: FROM the doctor 1,742 67 2,505 78
39 Physical Therapist 883 57 1,270 74
38b Covering/On-call nurse 1,430 64 2,092 74
42 Social Worker 1,302 57 1,802 73
43 Home Delivered Meals/Meals on Wheels 454 61 597 71
47 Audiology/Hearing Aids 525 59 737 70
40 Occupational Therapist 550 54 777 69
41 Speech Therapist 341 49 406 60

* Denominator excludes Not Applicable responses. Total responses to each survey item varied; percentages were calculated on the number of responses for each item, and exclude Not Applicable responses.
♦ Items based on skip pattern.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B4: Timely Access to Urgent Appointments (Same Day) – Comparison by Survey Year
  2013 2015 2013 v. 2015
Item Description Denom* Percent Denom* Percent
Section 2D: Access to Care - Urgent Appointments (Same day)
48 Regular doctor 1,755 45 2,885 50
51 Foot Doctor 1,039 26 1,912 34
50 Eye Care 1,195 22 2,165 33
52 Audiology/Hearing Aids 366 30 593 32
49 Dentist 920 26 1,526 29

* Denominator excludes Not Applicable responses. Total responses to each survey item varied; percentages were calculated on the number of responses for each item, and exclude Not Applicable responses.
♦ Items based on skip pattern.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B5: Timely Access to Regular Appointments (As Soon As Member Thought Appointment Needed) – Comparison by Survey Year
  2013 2015 2013 v. 2015
Item Description Denom* Percent Denom* Percent
Section 2C: Access to Care - Regular Appointments (Always/Usually)
53^ Regular doctor     3,328 88
56^ Foot Doctor     2,220 80
55^ Eye Care     2,486 79
54^ Dentist     1,873 73
57^ Audiology/Hearing Aids     723 68

* Denominator excludes Not Applicable responses. Total responses to each survey item varied; percentages were calculated on the number of responses for each item, and exclude Not Applicable responses.
^ Questions and/or responses have changed since 2013.
– 2015 results cannot be compared to 2013 results here, due to changes in responses.


Table B6: Plan Evaluation – Analysis of Composite Measures by Survey Year
  2013 2015 2013 v. 2015
Item Description N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 2,368 81% 3,738 86% p
Q4-Q5 ^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 2,459 66% 3,896 70% p
Q7-Q11 ^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually)     1,832 79% N/A 1
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 2,197 88% 3,702 94% p
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option     2,495 75% N/A 1
Q14a-d ^ The plan´s helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 2,231 83% 3,593 84%
Q15 Overall MLTC plan rating (Excellent/Good) 2,458 84% 3,739 87%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35 ^ The quality of care provided by the most utilized providers/services (Excellent/Good) 2,402 81% 3,884 81%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47 ^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 2,334 67% 3,774 82% p
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52 ^ Getting timely urgent appointments with the most utilized providers/services (Same day) 1,891 34% 3,166 39% p
Domain 5: Access to Care for Regular Appointments
Q53 – Q57 ^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually)     3,476 81% N/A 1
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 2,087 68% 3,757 67%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 2,145 61% 3,722 58%
Q73 The health plan has a copy of this document 956 77% 1,506 79%

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.
N/A1 Questions and/or responses changed in 2015. No comparison is possible.


Table B7: Analysis of Composite Measures – Comparison by Plan Type
  Plan Type
Partial Cap PACE MAP Partial Cap
vs.
PACE
vs.
MAP
Item Description N* % N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 2,709 86% 438 85% 591 86%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 2,800 70% 475 73% 621 69%
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 1,300 80% 243 80% 289 73% Partial Cap > MAP
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 2,677 94% 432 92% 593 95%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 1,831 77% 267 58% 397 74% Partial Cap, MAP > PACE
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 2,545 84% 467 86% 581 86%
Q15 Overall MLTC plan rating (Excellent/Good) 2,688 86% 453 86% 598 90%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 2,796 81% 474 83% 614 79%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 2,721 82% 465 86% 588 80% PACE > Partial Cap, MAP
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 2,248 40% 412 36% 506 37%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 2,512 83% 412 77% 552 79%
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 2,660 63% 497 77% 600 75% PACE, MAP > Partial Cap
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 2,645 53% 494 84% 583 61% PACE > MAP > Partial Cap
Q73 The health plan has a copy of this document 913 75% 348 94% 245 71% PACE > Partial Cap, MAP

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
– Not statistically significant.


Table B8: Analysis of Composite Measures – Comparison by Gender
  Gender
Male Female Male vs. Female
Item Description N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 900 88% 2,697 86%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 944 70% 2,806 70%
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 442 78% 1,333 79%
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 907 93% 2,666 95%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 651 76% 1,766 75%
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 875 84% 2,590 84%
Q15 Overall MLTC plan rating (Excellent/Good) 907 86% 2,704 88%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 943 80% 2,803 82%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 924 81% 2,730 82%
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 767 40% 2,298 38%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 843 80% 2,525 82%
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 940 62% 2,735 69%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 914 52% 2,732 61%
Q73 The health plan has a copy of this document 328 77% 1,147 80%

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B9: Analysis of Composite Measures – Comparison by Race
  Race
White Black Asian Other White vs. Black
vs.
Asian vs. Other
Item Description N* % N* % N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 1,645 87% 777 85% 506 84% 44 82%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 1,719 73% 838 66% 491 66% 44 69% White > Black
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 889 82% 379 74% 222 77% SS N/A White > Black
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 1,639 95% 789 95% 471 93% 44 95%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 1,078 74% 521 74% 315 79% SS N/A
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 1,585 86% 767 84% 485 80% 41 85% White > Asian
Q15 Overall MLTC plan rating (Excellent/Good) 1,666 88% 799 88% 481 83% 43 84%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 1,711 85% 822 77% 519 75% 44 76% White > Black, Asian
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 1,680 86% 794 78% 507 77% 42 80% White > Black, Asian
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 1,443 40% 661 37% 370 39% 34 40%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 1,565 86% 732 79% 437 74% 40 81% White > Black, Asian
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 1,687 67% 809 69% 458 62% 42 69%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 1,726 64% 800 59% 457 42% 43 65% White, Black, Other > Asian
Q73 The health plan has a copy of this document 768 85% 314 69% 145 79% SS N/A White, Asian > Black

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.
SS Sample size under 30 responses.
N/A Not applicable, as sample size is under 30 responses.


Table B10: Analysis of Composite Measures – Comparison by Level of Education
  Level of Education
Less than High School At least High School Less than High School vs. At least High School
Item Description N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 1,673 87% 1,851 86%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 1,747 71% 1,923 70%
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 784 80% 961 78%
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 1,651 94% 1,845 94%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 1,144 79% 1,205 70%
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 1,625 84% 1,771 85%
Q15 Overall MLTC plan rating (Excellent/Good) 1,680 87% 1,857 87%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 1,747 80% 1,920 82%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 1,700 81% 1,878 83%
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 1,438 39% 1,563 38%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 1,567 80% 1,730 83%
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 1,732 71% 1,875 65%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 1,661 57% 1,924 60%
Q73 The health plan has a copy of this document 650 77% 806 80%

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B11: Analysis of Composite Measures – Comparison by Age Group
  Age
18-64 Years 65+ Years 18-64 Years vs. 65+ Years
Item Description N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 520 83% 3,110 87%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 542 63% 3,234 72%
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 239 76% 1,545 79%
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 511 93% 3,084 94%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 361 70% 2,067 76%
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 502 83% 2,989 85%
Q15 Overall MLTC plan rating (Excellent/Good) 516 85% 3,117 88%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 538 78% 3,232 82%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 516 78% 3,157 83%
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 456 40% 2,619 39%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 486 79% 2,895 82%
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 523 64% 3,177 68%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 529 50% 3,138 60%
Q73 The health plan has a copy of this document 174 70% 1,306 80%

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B12: Analysis of Composite Measures – Comparison by Primary Language Spoken
  Primary Language
English Non-English English
vs.
Non-English
Item Description N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 2,103 85% 1,635 88%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 2,233 69% 1,663 72%
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 1,171 78% 661 80%
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 2,086 94% 1,616 94%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 1,323 67% 1,172 83%
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 2,039 84% 1,554 85%
Q15 Overall MLTC plan rating (Excellent/Good) 2,150 87% 1,589 87%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 2,202 81% 1,682 82%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 2,137 82% 1,637 83%
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 1,797 36% 1,369 42%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 1,960 81% 1,516 81%
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 2,165 69% 1,592 64%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 2,201 68% 1,521 44%
Q73 The health plan has a copy of this document 1,038 79% 468 78%

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.


Table B13: Analysis of Composite Measures – Comparison by Self-Reported Health Status
  Self-Reported Health Status
Good/Fair/Poor Excellent/Very Good Good/Fair/Poor vs. Excellent/Very Good
Item Description N* % N* %
Domain 1: MLTC Plan Evaluation
Q3 The plan explains all of their services clearly (Always/Usually) 2,133 83% 1,476 90%
Q4-Q5^ My family member (or caregiver) and I are involved in making decisions about my plan of care (Always/Usually) 2,210 68% 1,546 73%
Q7-Q11^ The plan provided helpful, timely, and courteous customer service when I or my caregiver or family members have called with a question, needed help, or had a complaint or grievance (Always/Usually) 1,064 74% 711 85%
Q12 Since joining the health plan, someone from the plan has asked to see all of the prescriptions and over the counter medicines I've been taking 2,119 95% 1,458 93%
Q13++ Since joining the health plan, someone from the plan has explained the Consumer Directed Personal Assistance option 1,436 74% 984 75%
Q14a-d^ The plan's helpfulness in assisting my family and I with medication management, managing my illness, helping me when I am sad and lonely, and allowing me to stay in my home instead of a nursing home (Excellent/Good) 2,067 81% 1,405 89%
Q15 Overall MLTC plan rating (Excellent/Good) 2,145 83% 1,471 93%
Domain 2: Quality of Providers and Long-Term Care Services
Q16 – Q35^ The quality of care provided by the most utilized providers/services (Excellent/Good) 2,231 78% 1,522 86%
Domain 3: Timeliness of Providers and Long-Term Care Services
Q36 - Q47^ The timeliness of care provided by the most utilized providers/services (Always/Usually) 2,171 80% 1,486 85%
Domain 4: Access to Care for Urgent Appointments
Q48 – Q52^ Getting timely urgent appointments with the most utilized providers/services (Same day) 1,820 38% 1,242 41%
Domain 5: Access to Care for Regular Appointments
Q53 – Q57^ Getting timely regular appointments with the most utilized providers/services since joining the health plan (Always/Usually) 2,015 80% 1,353 84%
Domain 6: Advance Directives
Q71 The health plan has talked to me about appointing someone to make decisions about my health if I am unable to do so 2,176 65% 1,506 70%
Q72 I have a legal document appointing someone to make decisions about my health care if I am unable to do so 2,166 55% 1,488 64%
Q73 The health plan has a copy of this document 799 78% 680 79%

N* Represents the denominator. For individual items, N* is the number of valid responses. For composite measures, N* is the number of members with at least one valid response to any question in the composite.
^ Indicates a composite measure.
++ New question in 2015.
▲/▼ Indicates a significantly higher/lower rate than 2013 (p < .001).
– Not statistically significant.

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Appendix C. Survey Tool

Appendix C. Survey Tool page 1.
Appendix C. Survey Tool page 2.
Appendix C. Survey Tool page 3.
Appendix C. Survey Tool page 4.
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1. The CAHPS® proportional scoring method for creating and scoring composite measures was used.  1