Partnering managed care and community-based services for frail elders: The care advocate program

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

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

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

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

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

Measurements: Sociodemographic characteristics of intervention participants, types of service referrals, and acceptance rates. RESULTS: Lessons learned included the importance of building a shared vision among partners, building on existing relationships between members and providers, and building trust without face-to-face interactions.

Conclusion: The program builds on current insured case management services and offers a practical bridge to community-based services.