2019 Findings from the Cal MediConnect Rapid Cycle Polling Project

2019 Findings from the Cal MediConnect Rapid Cycle Polling Project
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info 2019 Findings from the Cal MediConnect Rapid Cycle Polling Project Conducted for The SCAN Foundation In conjunction with The California Department of Health Care Services By Institute for Health and Aging, University of California, San Francisco May 2019

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info Report Objectives Previous reports looked at overall frequencies and compared those in Cal MediConnect (CMC), to those who opted out and those in non-demonstration counties. The prime objective of these analyses was to compare CMC enrollees’ experiences by county, race, language, and disability using the following characteristics: The seven participating counties: San Bernardino, San Diego, Santa Clara, San Mateo, Orange, Los Angeles, and Riverside Race: White, Black, Asian/Pacific Islander, and Hispanic/Latino Language of survey administration: English, Chinese, and Spanish Need for Long-Term Services and Supports (LTSS): No LTSS need, those with routine needs only, and those with need for personal care assistance

California’s Dual Financial Alignment Demonstration “Cal MediConnect”
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info California’s Dual Financial Alignment Demonstration “Cal MediConnect” Background: In 2014, California implemented a dual financial alignment demonstration called the Coordinated Care Initiative. As part of this demonstration new integrated health plans, called Cal MediConnect (CMC), were created in seven counties for people eligible for both Medicare and Medi-Cal. Dually eligible beneficiaries enrolled in CMC had all of their medical care, ancillary services, and long-term services and supports (LTSS) coordinated through one integrated managed care plan. CMC enrollees received some new benefits such as care coordination and non-emergency transportation. While specialty behavioral health was carved out, mild to moderate behavioral health benefits were provided through CMC, and CMC care coordinators were tasked with coordinating with specialty behavioral health county providers.

About the Surveys Survey Method
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info About the Surveys Survey Method Telephone interviews with stratified random samples of dual eligible beneficiaries in Cal MediConnect (CMC) counties Populations Surveyed 2015: CMC enrollees in five counties (Los Angeles, Riverside, San Bernardino, San Diego, and Santa Clara) 2016 through 2018: CMC added two counties (San Mateo and Orange) Sample Sizes of CMC Enrollees by Survey Year 2015: 2,764 CMC enrollees 2016: 3,351 CMC enrollees 2017: 1,779 CMC enrollees 2018: 1,775 CMC enrollees Aggregate Sample Size of CMC Enrollees (across all years) 9,669 CMC enrollees

CMC Enrollees by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info CMC Enrollees by County Sample of CMC Enrollees by County and Year County 2015 2016 2017 2018 Los Angeles 1,021 905 716 827 Riverside 429 409 208 144 San Bernardino 458 399 162 199 San Diego 403 226 180 Santa Clara 457 405 130 111 San Mateo 526 99 114 Orange 304 238 200

CMC Enrollees by Race and Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info CMC Enrollees by Race and Language Sample of CMC Enrollees by Race and Language of Survey Administration and Year *Note: Race sample size=8907. Respondents who answered “other” or “not recorded” were excluded from the analysis. Race* 2015 2016 2017 2018 White non-Hispanic 645 813 446 349 Hispanic/Latino 1,297 1,772 736 800 Black 293 324 211 182 Asian/Pacific Islander 262 326 197 254 Language of Administration 2015 2016 2017 2018 English 1,582 2,015 1,181 1,027 Spanish 1,051 1,258 506 581 Chinese 131 78 92 167

CMC Enrollees by Need for Long-Term Services and Supports
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX Contact Info CMC Enrollees by Need for Long-Term Services and Supports Sample of CMC Enrollees by Type of LTSS Needs and Year LTSS Needs* 2017 2018 No LTSS Needs 1,119 1,076 Routine Care Needs only** 235 215 Personal Care Needs*** 383 432 * This item about LTSS needs distinguished between no LTSS needs, personal care needs, and routine care needs and was only asked in 2017 and 2018. ** Routine needs were defined as needing help with everyday household chores, doing necessary business, shopping or getting around for other purposes. This category only includes those who need only routine care, and does not include those who need both routine and personal care. *** Personal care needs were defined as needing help with eating, bathing, dressing, or getting around inside the home. Most people who needed personal care also needed routine care.

Summary Findings in Brief
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Summary Findings in Brief

CMC Enrollees’ Confidence Navigating Health Care
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Confidence Navigating Health Care Confidence navigating health care was fairly high for all CMC enrollees, and seemed to increase between 2015 to While there were no significant differences in 2018 by county, there were some significant differences by race, language, and disability. By race, Asian/Pacific Islanders (API) expressed less confidence than White or Black groups in their confidence managing their health conditions, knowing who to call, and getting their questions answered. By language, English-speaking CMC enrollees were significantly more likely to be “very confident” on all measures compared to Spanish speakers and Chinese- speaking enrollees. By disability, those CMC enrollees who had no LTSS needs expressed higher confidence that they could manage their health conditions and that they could get their questions answered compared to CMC enrollees with only routine needs, or those with personal care needs.

CMC Enrollees’ Satisfaction with Health Care Services
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Satisfaction with Health Care Services There were some significant differences across counties in satisfaction with choice of doctors and choice of hospitals by race, language, and disability. By race, there were significant differences across all satisfaction questions. In particular, Latinos were least likely to say they were “very satisfied” with their choice of doctors and hospitals. Both Latinos and API were least likely to be very satisfied with their ability to call a health provider regardless of the time of day. By language, English-speaking CMC enrollees were most likely to be satisfied with almost all aspects of their health care compared to Spanish- and Chinese- speaking enrollees. By disability, CMC enrollees with personal care needs were the most satisfied with the hospitals they could use. Those with no LTSS needs were most satisfied with how long they had to wait to see a doctor when they needed an appointment.

CMC Enrollees’ Problems Encountered with Health Care
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Problems Encountered with Health Care There were few differences by county in problems encountered with health care, with the exception of a question only asked of non-English-speaking enrollees about access to interpreters. Those in Santa Clara and San Mateo Counties were the most likely to say they were not provided an interpreter when they needed one. By race, White enrollees were most likely to report misunderstandings about coverage, denied treatment, or that a doctor was not available. In contrast, API enrollees were most likely to report problems accessing interpreters, transportation problems, and trouble communicating with providers. Language was similar to race in that English-speaking enrollees were most likely to report misunderstandings about coverage, denied treatment, or that a doctor was not available. Chinese–speaking enrollees were most likely to report problems accessing interpreters and transportation problems. CMC enrollees with personal care needs were more likely than those with routine needs or no needs to report problems in all six areas queried.

CMC Enrollees’ Experiences with a Personal Doctor*
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Experiences with a Personal Doctor* By 2018, CMC enrollees in San Mateo County were the most likely to say they had a personal doctor. They were also the most likely to say that their personal doctor was the same doctor they had before they transitioned to CMC. By race, API CMC enrollees were the most likely to report having a personal doctor and also the most likely to say their doctor was the same that they had before CMC. White CMC enrollees were the most likely to say they had been seeing their personal doctor for a year or less. Similarly, by language, 100% of Chinese-speaking CMC enrollees said they had a personal doctor and they were the most likely to have been seeing the same doctor since before CMC. By disability, CMC enrollees with personal care needs were the most likely to say they had a personal doctor and slightly more likely than those with no LTSS needs or routine needs to say they had the same doctor since before CMC. * A “personal doctor” was defined in the survey as “the doctor who knows you best and can refer you to other doctors when you need to see a specialist.”

CMC Enrollees’ Use of Single Care Managers and Personal Care Plans
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Use of Single Care Managers and Personal Care Plans There were few differences by county in those who reported having a single care manager,* with the exception that CMC enrollees in San Mateo County who did have a single care manager were the most likely to say their single care manager was from the plan. By race, API were the most likely to report having a single care manager, but the least likely to report having a personal care plan.** Latino and Black CMC enrollees who had a single care manager were most likely to say that the single care manager improved their care “a lot.” By language, English-speaking CMC enrollees were the most likely to report they had a single care manager and personal care plan. Chinese speakers who had a single care manager were the least likely to say it had improved their care “a lot.” By disability, those with personal care needs were significantly more likely to have a single care manager and personal care plan compared to those with no LTSS needs or only routine needs. * A single care manager was defined in the survey as a nurse or other helper from their health plan who serves as their main point of contact and can arrange all aspects of their care. ** A personal care plan was defined in the survey as a plan designed to take into account their health goals, needs and preferences.

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Long-Term Services and Supports Needs and Use of In-Home Supportive Services There were significant differences by county in the percentage of CMC enrollees getting assistance with care needs, getting In-Home Supportive Services (IHSS), their monthly IHSS hours, and unmet needs for personal care*. By race, API CMC enrollees were the most likely to say that they need assistance with personal care and reported the highest unmet needs. API and Black CMC enrollees were more likely than White and Latino enrollees to report using IHSS. By language, Chinese-speaking CMC enrollees were the most likely to report having needs for assistance with personal care, using IHSS, and the most likely to report unmet needs for personal care. By disability, those with personal care needs were most likely to get assistance with personal care, most likely to get IHSS, and had the highest average monthly hours compared to those with fewer needs. They were also the most likely to have unmet needs. * Personal care needs defined as: eating, bathing, dressing, or getting around inside the home. ** Routine needs defined as: everyday household chores, doing necessary business, shopping or getting around for other purposes

Results by CMC Counties
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Results by CMC Counties

CMC Enrollees’ Confidence Navigating Health Care
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Confidence Navigating Health Care by County CMC enrollees across all counties expressed high levels of confidence in navigating their health care. In 2015, just under half of enrollees in all counties said they were very confident they knew how to manage their health conditions. By 2017, over half of CMC enrollees in most counties said they were very confident, with no significant differences by county. A majority of enrollees also said they “know who to call” if they have a health need or a question about their health. The only year there was a significant difference across counties was in 2017, when San Mateo County had the highest percentage of endorsement at 93% and Los Angeles County had the lowest endorsement at 85%. By 2018, there were no longer significant differences by county.

CMC Enrollee Confidence Getting Questions Answered by County - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollee Confidence Getting Questions Answered by County P-VALUE: 0.043

Personal Doctor by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Doctor by County In 2018, for the first time there were differences by county in CMC enrollees who said they had a personal doctor. 100% of San Mateo County enrollees said they had a personal doctor, while 89% of San Diego County CMC enrollees said they had a personal doctor. In 2016 (the first year that San Mateo County was included), 76% of CMC enrollees in San Mateo County said that they still had the same personal doctor they had before enrolling in CMC. By 2018, San Mateo County was still the highest at 70%, with Orange County the lowest at 59%.

Personal Care Doctor by County - 2016 and 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Care Doctor by County and 2018

Choice of Providers by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Choice of Providers by County In 2018, 91% of San Mateo County CMC enrollees said they were very or somewhat satisfied with their choice of doctors (the highest of all the counties). In 2018, over 90% of San Mateo County and San Bernardino County CMC enrollees said they were very or somewhat satisfied with their choice of hospitals (the highest of all the counties).

Choice of Doctor by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Choice of Doctor by County P-VALUE: 0.012

Choice of Hospital by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Choice of Hospital by County P-VALUE: 0.019

Specific Problems with Health Care Services by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services by County Relatively small proportions of CMC enrollees said they encountered any of six specific problems relating to their health services in the recent past. The only specific problem that was significantly different by county was among non-English-speaking enrollees who were asked if their doctor did not speak their language and an interpreter was not provided. The highest percentages were reported by CMC enrollees in Santa Clara County (36%) and San Mateo County (30%). The lowest percentages were reported in Riverside and San Bernardino Counties (8% and 6%, respectively).

Specific Problems with Health Care Services – 2018 (1)
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services – 2018 (1) Had a misunderstanding about your health care services or coverage Was denied a treatment or referral for another service recommended by a doctor

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services – 2018 (2) Transportation problems kept you from getting needed health care A doctor you were seeing is not available through your plan

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services – 2018 (3) Had trouble communicating with a health provider because of a speech, hearing or other disability Doctor did not speak your language and there was not an interpreter available by county* * P-VALUE: <0.001

Single Care Manager and Personal Care Plan by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager and Personal Care Plan by County There were no significant differences by county in the percent of CMC enrollees who reported having a single care manager or personal care plan. Of those who did have a single care manager in 2018, 88% of San Mateo County CMC enrollees said their single care manager was from the plan (highest %), compared to 56% of Orange County CMC enrollees (lowest %). Thirty-five percent of Santa Clara County CMC enrollees who did not have a single care manager said that having one would improve their care “a lot.”

Single Care Manager by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager by County P-VALUE: 0.001

Single Care Manager from the CMC Plan
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager from the CMC Plan P-VALUE: 0.011

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Health and Disability Related Characteristics of CMC Enrollees by County In 2018, there were NO differences in health/disability characteristics by county in the following measures: Self-rated health Hospital admissions Use of mental health services Use of medical equipment and supplies Deaf or serious difficulty hearing Blind or serious difficulty seeing while wearing glasses Difficulty walking or climbing stairs Difficulty dressing or bathing Doing errands alone or visiting a doctor’s office or shopping

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS LTSS NEED APPENDIX Getting Services or Assistance with Personal Care and Routine Care by County In 2018 there were differences by county in: Getting services or assistance with bathing, dressing, help preparing meals, help doing housework, or grocery shopping. San Bernardino County at 29% and Orange County at 19% were the lowest. Those with a disability using In-Home Supportive Services (IHSS). Orange and San Diego Counties were the lowest at 15% and 20%, respectively; Los Angeles, Santa Clara and San Mateo Counties were the highest at 34%. Average number of monthly IHSS hours among users differs significantly by county. Orange County was the lowest at 72 hours, while San Mateo and Santa Clara Counties were the highest at over 100 hours. There was no significant difference by county in unmet needs reported for personal or routine care. Between 32% and 46% in all the counties reported they ”could use more help with personal care needs.” Irene, do a chart of each of these.

Getting Services or Assistance with Routine or Personal Care - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Getting Services or Assistance with Routine or Personal Care Personal care needs P-VALUE: 0.020; Routine care needs P-VALUE: 0.016

Getting All the Help Needed for Personal Care Needs by County - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Getting All the Help Needed for Personal Care Needs by County

Housework or Shopping by County
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Getting Services or Assistance with Bathing, Dressing, Help with Preparing Meals, Housework or Shopping by County P-VALUE: <0.001

IHSS Use Among People with LTSS Needs – 2017 and 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX IHSS Use Among People with LTSS Needs – and 2018 Asked only of enrollees who report using LTSS, 2017 & 2018 P-VALUE: <0.001

IHSS Use Among People with LTSS Needs
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX IHSS Use Among People with LTSS Needs County 2017 Average Hours per Month 2018 Los Angeles 87 90 Riverside 92 San Bernardino 86 San Diego 67 91 Santa Clara 111 108 San Mateo 93 113 Orange 72 Asked only of enrollees who report using IHSS

Results by Race INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX
Contact Info APPENDIX Results by Race

Enrollees’ Confidence Navigating Health Care by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Enrollees’ Confidence Navigating Health Care by Race In 2018, similar to previous years, White and Black CMC enrollees were significantly more likely than Latinos or Asian/Pacific Islander (API) enrollees to say: Very or somewhat confident they know how to manage their health conditions (91% of White and Black enrollees, compared to 77% of Latinos and 75% of API enrollees). Asian/Pacific Islanders were also least likely to say: They know who to call if they have a question about their health (82%, compared to 88% of Latinos, 94% of White and Black enrollees). They know how to get their questions answered (51%, compared to 64% of White and 66% Black enrollees).

Enrollees’ Confidence Navigating Health Care by Race - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Enrollees’ Confidence Navigating Health Care by Race Know how to manage your health conditions (% very or somewhat confident) Know who to call if you have a health need or question (% yes) Can get questions about your health needs answered (% very or somewhat confident)

Personal Doctor by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Doctor by Race API CMC enrollees were most likely to have a personal doctor (98%). API CMC enrollees were also the most likely to have the same doctor they had before enrolling in CMC (75%, compared to 66% Black enrollees, 60% Latinos, and 53% of White CMC enrollees). White CMC enrollees were the most likely to have been seeing their personal doctor less than a year (21%).

Has a Personal Doctor by Race - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Has a Personal Doctor by Race P-VALUE: 0.002

Satisfaction with Health Care Services by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race There were significant differences by race for all questions related to satisfaction with care in Latinos were least likely to say they were “very satisfied” with their choice of doctors and hospitals in 2018 (only 25% were very satisfied). Both Latinos and API were the least likely to be very satisfied with their ability to call a health provider regardless of the time of day.

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race Choice of Doctors – 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race Choice of Hospitals – 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race Information Given Explaining Benefits – 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race Ability to Call Health Plan Regardless of Time of Day – 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race Time Your Doctor and Other Staff Spend With You– 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race Wait Time To See Your Doctor When You Need an Appointment – 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Race The Way Different Health Care Providers Work Together to Give You the Services You Need – 2018 P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Enrollees’ Experiences with Single Care Manager and Personal Care Plan by Race API CMC enrollees were most likely to report they had a single care manager from the CMC plan (75% compared to 63% of Black enrollees). Latino and Black CMC enrollees who had a single care manager were most likely to say that the single care manager improved their care “a lot” (68% of Latinos and 65% of Black CMC enrollees, compared to only half of White or API enrollees). API CMC enrollees were least likely to have a personal care plan (only 18% of API, compared to about a quarter of White and Latinos, and 38% of Black enrollees).

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Enrollees’ Experiences with Single Care Manager and Personal Care Plan by Race Single care manager from the CMC plan Personal care plan P-VALUE: 0.001

Specific Problems with Health Care Services by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services by Race White CMC enrollees were most likely to report the following problems in 2018: Misunderstanding about your health care services or coverage (20%) Health plan denied a treatment or referral recommended by a doctor (19%) A doctor you were seeing was not available through your plan (20%) API CMC enrollees were most likely to report the following problems in 2018: Your doctor did not speak your language or there was not an interpreter available when you visited your doctor or other health care professional (40% of API enrollees compared to 9% of Hispanic/Latino enrollees)* Transportation problems kept you from getting needed health care (20%) Had trouble communicating with a doctor or health care provider because of a speech, hearing or other disability (23%) * Only asked of respondents who took the survey in a language other than English.

Long-Term Services and Supports Use and Need of CMC Enrollees by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Long-Term Services and Supports Use and Need of CMC Enrollees by Race API CMC enrollees were the most likely to say that they need assistance with personal care (68% compared to 43% of White enrollees). Black CMC enrollees were most likely to say they need assistance with routine needs such as chores, shopping, and getting around (82%). API CMC enrollees were the mostly likely to say they had unmet needs for personal or routine care. Forty-six percent of API, 38% of Latinos, 37% of White, and 36% of Black CMC enrollees had unmet need for long-term services and supports (LTSS). API and Black CMC enrollees were the most likely to report using In-Home Supportive Services (IHSS) (43% and 42%, respectively). White (23%) and Latinos (24%) were the least likely to report using the service for personal care.

Unmet Needs for LTSS by Race - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Unmet Needs for LTSS by Race Do you usually get all the help you need with personal care and/or routine needs? (% needing more help) P-VALUE: 0.001 Currently using IHSS P-VALUE: 0.004

Comparing the Health Characteristics by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Comparing the Health Characteristics by Race In 2018, Black CMC enrollees were the most likely to say they were in fair or poor health (65%, compared to 56% of API, 47% of Latinos, and 43% of White CMC enrollees). API CMC enrollees were the least likely to report hospitalization in the last year (14%, compared to about a quarter of other races).

Comparing the Demographic Characteristics of CMC Enrollees by Race
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Comparing the Demographic Characteristics of CMC Enrollees by Race API CMC enrollees are much more likely to be 75 years old or older (71%), compared to only 33% of White enrollees, and 34% of Black enrollees. Black and White CMC enrollees are much more likely to live alone (44% and 38%, respectively), compared to only 8% of API and 17% of Latino/Hispanic CMC enrollees.

Results by Language INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX
Contact Info APPENDIX Results by Language

Enrollees’ Confidence Navigating Health Care by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Enrollees’ Confidence Navigating Health Care by Language It is no surprise that there were major differences by language in CMC enrollees’ confidence managing health care in all years. In 2018, 64% of English-speaking CMC enrollees said they were very confident they knew how to manage their health conditions, compared to only 20% of Chinese-speaking and 48% of Spanish-speaking enrollees. In 2018, 92% of English speakers said they knew who to call if they had a health need or questions about their health, compared to 87% of Spanish speakers and 77% of Chinese speakers. Finally, while 66% of English speakers said they were very confident they could get their questions answered, only 43% of Spanish speakers and 36% of Chinese speakers had the same confidence.

Enrollees’ Confidence Navigating Health Care by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Enrollees’ Confidence Navigating Health Care by Language Know how to manage your health conditions (% very or somewhat confident) Know who to call if you have a health need or question (% yes) Can get questions about your health needs answered (% very or somewhat confident)

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Confidence Getting Questions Answered by Language P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Confidence Getting Questions Answered by Language Know who to call if you have a health need or question (% yes) P-VALUE: <0.001

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Confidence Getting Questions Answered by Language Confidence Getting Questions Answered P-VALUE: <0.001

Personal Doctor by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Doctor by Language In 2018, 100% of Chinese-speaking CMC enrollees said they had a personal doctor. This was an increase from 92% in In 2018, 92% of English-speaking CMC enrollees and 94% of Spanish-speaking enrollees said they had a personal doctor. In 2018, 75% of Chinese speakers reported they had the same doctor as before enrolling in the program, compared to only 63% of English speakers and 57% of Spanish speakers.

Personal Doctor by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Doctor by Language Having a personal doctor Having the same doctor as before enrolling in CMC

Satisfaction with Health Care Services by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by Language English speakers were the most likely to be “very satisfied” with the following aspects of their health care*: Choice of hospitals (38%, compared to about 20% of Spanish and Chinese speakers) Information the health plan has given you explaining your benefits (36%, compared to 25% of Spanish speakers and 21% of Chinese speakers) Ability to call a health care provider regardless of the time of day (33%, compared to 16% of Spanish speakers and 13% of Chinese speakers) The amount of time your doctor and other staff people spend with you (43%, compared to 25% of Spanish speakers and 28% of Chinese speakers) How long you have to wait to see a doctor when you needed an appointment (34%, compared to 18% of Spanish speakers and 20% of Chinese speakers) The way different health care providers work together to give you the services you need (36%, compared to 19% Spanish speakers and 22% Chinese speakers) * Most of these differences are no longer significant if you collapse “very satisfied” with “satisfied” Orange

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language Choice of Doctor

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language Choice of Hospital

Information Given Explaining Benefits – 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language Information Given Explaining Benefits – 2018

Ability to Call Health Plan Regardless of Time of Day – 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language Ability to Call Health Plan Regardless of Time of Day – 2018

Time Your Doctor and Other Staff Spend With You – 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language Time Your Doctor and Other Staff Spend With You – 2018

Wait Time To See Your Doctor When You Need an Appointment – 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language Wait Time To See Your Doctor When You Need an Appointment – 2018

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Different Aspects of the Health Care Services by Language The Way Different Health Care Providers Work Together to Give You the Services You Need – 2018

Single Care Manager and Personal Care Plan by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager and Personal Care Plan by Language English speakers were the most likely to have a single care manager (32%, compared to 16% of Spanish and Chinese speakers). Chinese-speaking CMC enrollees who had a single care manager were the least likely to say their single care manager has improved their care “a lot” (only 30%, compared to 60% of English speakers and 62% of Spanish speakers). English-speaking CMC enrollees were the most likely to say they had a personal care plan (30%, compared to 23% of Spanish speakers and 12% of Chinese speakers).

Single Care Manager and Personal Care Plan by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager and Personal Care Plan by Language Having a single care manager Having a personal care plan

Specific Problems with Health Care Services by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services by Language English-speaking CMC enrollees were the most likely to report the following problems in 2018: Had a misunderstanding about health care services or coverage (18%, compared to less than 10% of Spanish and Chinese speakers) Health plan denied treatment or referral for another service recommended by a doctor (18%, compared to less than 10% of Spanish and Chinese speakers) A doctor you were seeing was not available through the plan (18%, compared to 16% of Spanish speakers and 3% of Chinese speakers) Chinese-speaking CMC enrollees were the most likely to report the following problems: Doctor did not speak your language or there was not an interpreter available (38%, compared to 8% of Spanish speakers) Transportation problems kept you from getting needed health care (26,% compared to 13% of English speakers and 8% of Spanish speakers)

Specific Problems with Health Care Services by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services by Language Transportation problems kept you from getting needed health care

Health-Related Characteristics of CMC Enrollees by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Health-Related Characteristics of CMC Enrollees by Language Spanish speakers were most likely to report their health was fair or poor (48%, compared to 41% of English speakers and 37% of Chinese speakers). English-speaking CMC enrollees were most likely to report using specialized equipment such as a cane, wheelchair, scooter, or special bed, etc. (48%, compared to 40% of Spanish speakers and 30% of Chinese speakers). English-speaking CMC enrollees were most likely to report they had been in the hospital overnight in the last 12 months (23%, compared to 20% of Spanish- speakers and 9% of Chinese speakers). English-speaking CMC enrollees were most likely to report using mental health care (19%, compared to less than 10% of the other groups).

Health-Related Characteristics of CMC Enrollees by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Health-Related Characteristics of CMC Enrollees by Language Global Self-Rating of Health

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Disability and Long-Term Services and Supports Use of CMC Enrollees by Language Chinese-speaking CMC enrollees were most likely to report needing assistance with personal care (76%, compared to 54% of English-speaking enrollees and 43% of Spanish-speaking enrollees). Chinese-speaking enrollees were the most likely to be using In-Home Supportive Services (IHSS) (60%), compared to about a quarter of English- and Spanish-speaking CMC enrollees. There were no significant differences by language in need for assistance with routine activities like chores, shopping, or getting around for other purposes. Spanish-speaking CMC enrollees were the least likely to report unmet needs for personal and routine care (33%, compared to 42% for English speakers and 44% for Chinese speakers).

Disability and LTSS Use of CMC Enrollees by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Disability and LTSS Use of CMC Enrollees by Language Personal care needs Routine care needs

Other Demographics by Language
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Other Demographics by Language In 2018, English-speaking CMC enrollees were the most evenly split by gender, with 46% male and 54% female. Spanish- and Chinese-speaking enrollees were 60% female. Chinese-speaking CMC enrollees were by far the oldest, with 87% aged 75 or older, compared to 36% of English-speaking enrollees and 49% of Spanish-speaking enrollees. Thirty-three percent of English-speaking CMC enrollees lived alone. This was significantly higher than Spanish-speaking (13%) or Chinese-speaking (6%) enrollees.

Results by Need for Long-Term Services and Supports
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Results by Need for Long-Term Services and Supports

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollee Confidence Navigating Health Care by Long-Term Services and Supports Need Respondents were put into three different categories based on their self- reported need for long-term services and supports (LTSS), including: 1) No need for LTSS; 2) Needs assistance with routine tasks; and 3) Needs assistance with personal care (bathing, dressing, eating). In 2018, CMC enrollees with no LTSS needs were more likely to feel “very confident” that they know how to manage their health conditions (61%, compared to 51% of CMC enrollees with routine care needs and 44% of those with personal care needs). Fifty-six percent of CMC enrollees with no LTSS needs or just routine needs (57%) were slightly more likely to feel “very confident” they could get their questions answered, compared to those with personal care needs (54%).

CMC Enrollee Confidence Navigating Health Care by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollee Confidence Navigating Health Care by LTSS Need Confidence Managing Conditions

Personal Doctor by LTSS Needs
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Doctor by LTSS Needs In 2018, 95% of CMC enrollees with personal care needs said they had a personal doctor. This is slightly higher than those with no LTSS need (93%) and those with only routine needs (94%). Sixty-four percent of CMC enrollees with personal care needs said that their personal doctor was the same doctor they had before enrolling in CMC. This is slightly higher than those with no LTSS needs (63%) and much higher than those with only routine needs (55%).

Personal Doctor by LTSS Needs
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Personal Doctor by LTSS Needs Having a personal doctor Having the same doctor as before enrolling in CMC

Satisfaction with Health Care Services by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by LTSS Need Eighty-two percent of CMC enrollees with personal care needs were satisfied with the hospitals they could use. This is slightly higher than the 79% of those with no LTSS needs or only routine needs who were similarly satisfied. Eighty-two percent of CMC enrollees with no LTSS needs were satisfied with their wait time to see a doctor when they needed an appointment. This is higher than the 75% of those with routine needs, and 77% of those with personal care needs.

Satisfaction with Health Care Services by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Satisfaction with Health Care Services by LTSS Need Choice of Hospital -2018

Single Care Manager and Personal Care Plan by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager and Personal Care Plan by LTSS Need CMC enrollees with personal care needs were most likely to have a single care manager (34%) compared to those with no LTSS needs (21%) and those with only routine needs (28%). CMC enrollees with personal care needs were also most likely to have a personal care plan (32%) compared to those with no LTSS need (24%) and those with only routine needs (29%).

Single Care Manager and Personal Care Plan by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Single Care Manager and Personal Care Plan by LTSS Need Having a single care manager Having a personal care plan

Specific Problems with Health Care Services by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services by LTSS Need CMC enrollees with personal care needs were more likely than those with no LTSS needs and those with only routine needs to experience all six of the following problems with their health care services: Having a misunderstanding about their health care services Health plan denied treatment or referral for another service recommended by a doctor [For non-English interviews] Your doctor did not speak your language or there was not an interpreter available for you when you visited your doctor or other health care professional Transportation problems kept you from getting needed health care A doctor you were seeing was not available through your plan You had trouble communicating with a doctor or health car provider because of a speech, hearing, or other disability

Specific Problems with Health Care Services by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Specific Problems with Health Care Services by LTSS Need NO LTSS ROUTINE PERSONAL SIGNIFICANCE Had a misunderstanding about your health care services or coverage 13% 15% 18% *** Was denied a treatment or referral for another service recommended by a doctor 11% 16% ** Health provider did not speak your language and no interpreter was available (among non- English speakers) 10% 23% Transportation problems kept you from getting needed health care 8% 17% A doctor you were seeing was not available through your plan 14% 24% Had trouble communicating with a health provider because of a speech, hearing or other disability 6% Note: *p<0.05, **p<0.01, ***p<0.001

Health-Related Characteristics of CMC Enrollees by LTSS Need
Overall Health-Related Characteristics of CMC Enrollees by LTSS Need Los Angeles Riverside More CMC enrollees with personal care needs reported their health as fair/poor (65%) compared to those with no LTSS needs (34%) and those with routine needs only (60%). More CMC enrollees with personal care needs had been hospitalized overnight in the last 12 months (33%), compared to those with no LTSS needs (14%) and those with only routine needs (27%). San Bernardino San Diego Santa Clara San Mateo Orange

Health-Related Characteristics of CMC Enrollees by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Health-Related Characteristics of CMC Enrollees by LTSS Need Health reported as “fair/poor” Was hospitalized in the last 12 months

LTSS Use and Unmet Need of CMC Enrollees by LTSS Need
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX LTSS Use and Unmet Need of CMC Enrollees by LTSS Need Seventy-seven percent of CMC enrollees with personal care needs reported using specialized equipment such as a cane, wheelchair, scooter, special bed, or other assistive device, compared to 28% of those with no LTSS need and 57% of those with routine needs only. Seventy-seven percent of CMC enrollees with personal care needs were getting assistance with LTSS, compared to 10% of those with no LTSS needs and 47% of those with routine needs only. Forty-four percent of CMC enrollees with personal care needs had unmet needs for LTSS, compared to 33% of those with routine needs only. Of those with routine needs only, 41% were getting In-Home Supportive Services (IHSS). Of those with personal care needs (average of 75 hours per month), 70% were getting IHSS (average of 100 hours per month).

LTSS Use and Unmet Need of CMC Enrollees by LTSS Need - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX LTSS Use and Unmet Need of CMC Enrollees by LTSS Need Getting assistance (bathing, dressing, preparing meals, housework, or grocery shopping) Do you usually get all the help you need? (I could use more help)

CMC Enrollees by LTSS Need - 2018
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees by LTSS Need

Appendix INTRO SUMMARY COUNTY RACE LANGUAGE LTSS APPENDIX
Contact Info APPENDIX Appendix

CMC Enrollees’ Other Characteristics (1)
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Other Characteristics (1) Education Overall, San Bernardino County had the highest percentage of CMC enrollees who were high school graduates (26%) and San Mateo County had the highest percentage of college graduates (17%). Overall, Hispanic/Latino CMC enrollees had the highest percentage of individuals having some high school or less (69%). Asian/Pacific Islanders had the second highest percentage of enrollees with some high school or less (34%). The percentage of Asian/Pacific Islanders with a college degree was also the highest (25%). The number of enrollees having LTSS needs who graduated college increased from 2015 (7.3%) to 2018 (10%) Age Santa Clara and San Mateo Counties had the largest percentage of CMC enrollees over the age of 75, and this older population has grown since

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Other Characteristics (2) Age (cont’d) Santa Clara County had 42% of their enrollees 75 years old or older in 2015, and by 2018 this percentage grew to 56%. San Mateo County had 48% of their enrollees 75 years old or older in 2016, and by 2018 this percentage grew to 65%. Los Angeles County also experienced a similar growth from 2015 (33%) to (50%) in its oldest CMC enrollees. Asian/Pacific Islanders have the largest percentage of enrollees who are older than 75 years of age (2015: 57%, 2018: 70%). Older individuals with LTSS needs have also increased over the surveyed years (2015: 40%, 2018: 54%).

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX CMC Enrollees’ Other Characteristics (3) Gender There are a greater number of female CMC enrollees compared to males across all characteristics and years. The difference in percentage of females compared to male enrollees is most apparent for Hispanic/Latino, Black, and Asian/Pacific Islander enrollees. Across all years, more females than males have LTSS needs. Household Composition San Diego County has the largest percentage of enrollees who live alone (2018: 34%). Across all years, White non-Hispanic (2018: 38%) and Black (2018: 44%) enrollees have the largest percentage of individuals living alone, compared to Hispanic/Latino (2018: 17%) and Asian/Pacific Islander (2018: 8%) enrollees.

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Methodology IBM SPSS Statistics for Macintosh, Version 21.0 was used for statistical analyses such as frequencies and chi-squared tests to compare differences across comparison groups within survey year. IBM SPSS Statistics for Windows, Version 23.0 was used to weight the data to adjust the polling sample so that it was representative of the target population. Weights were derived using a form of post-stratification weighting known as Raking or RIM weighting. RIM weighting permits the adjustment of multiple characteristics in a dataset all at the same time in a way that it keeps the different characteristics proportionate as a whole. The following population estimates were obtained from DHCS in 2017 and used with the SPSS Raking procedure – gender (male, female); language (ASL, Spanish, Cantonese, Mandarin, English, other sign languages); age; and county. Weights were determined separately for the three groups: CMC enrollees, dually eligible beneficiaries who chose to opt-out of the CMC program, and dually eligible beneficiaries in non-participating CMC counties.

Research Team Carrie Graham, PhD, MGS, Principal Investigator
INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX Research Team Carrie Graham, PhD, MGS, Principal Investigator Leslie Ross, PhD, Research Specialist Irene Liu, Research Assistant University of California, San Francisco Institute for Health and Aging

INTRO SUMMARY COUNTY RACE LANGUAGE LTSS Contact Info APPENDIX For questions or comments, please contact: Carrie Graham, PhD, MGS

2019 Findings from the Cal MediConnect Rapid Cycle Polling Project

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2019 Findings from the Cal MediConnect Rapid Cycle Polling Project

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