| Sumario: | BACKGROUND: Persons who are dually eligible for Medicare and Medicaid generate disproportionately high costs. Individuals younger than 65 years of age who qualify for Medicare because of disability are especially costly, as they require expensive long-term services and supports (LTSS) needs. To explore efficient health care delivery models for these beneficiaries, the Centers for Medicare & Medicaid Services (CMS) initiated demonstration programs for dually eligible individuals. The Massachusetts One Care program is CMS's only demonstration program nationwide that targets younger beneficiaries: individuals aged 21 to 64 years. As CMS and Massachusetts Medicaid designed One Care, which involves dually capitated payments to plans and covers all services including LTSS, local disability advocates voiced concerns about threats to care quality. They argued that persons with disability should be the ones leading efforts to assess One Care quality, highlighting fears related to independent living in communities. OBJECTIVES: This study aimed to test the comparative effectiveness for improving patient-reported health care experiences of 2 informational interventions in a 12-month period: (1) the "YES Health: Your Experience, Speak up for better health care" initiative, in which disability advocates developed brief topical surveys and gathered information from One Care enrollees with significant physical disability or serious mental illness; and (2) the Persons With Disability Quality Survey (PDQ-S), developed collaboratively with persons with disability. METHODS: We focused on English- and Spanish-speaking One Care members with either serious mental illness or significant physical disability. This cluster randomized controlled trial randomly assigned 27 primary care practices with ≥50 One Care members meeting these specifications to 3 study arms differing by information provided to practice directors and primary care providers (PCPs): (1) quarterly YES Health reports plus results from baseline administration of PDQ-S to 720 enrollees before YES Health implementation; (2) PDQ-S results only; and (3) no study information. We administered PDQ-S again 1 year later and used difference-in-differences analyses of results across the 2 years to assess intervention outcomes. After YES Health concluded, we surveyed the 221 PCPs listed as serving sample members at the 27 practices. RESULTS: Led by individuals with significant physical disability or serious mental illness, YES Health engaged 45 persons--with disabilities from the 9 randomly assigned practices--in surveys evaluating their One Care quality. Topics selected for the quarterly YES Health quality surveys were One Care plans and care teams, communication with clinicians, LTSS, and transportation. However, PCPs at the 9 study arm 1 practices did not engage with the disability advocates, despite repeated outreach. With minimal exceptions, we found no differences across the 3 study arms in PDQ-S member-reported outcomes. Of the 110 eligible PCPs who responded to the survey (54.4%), few reported knowing about YES Health or baseline PDQ-S results. CONCLUSIONS: Individuals with disability successfully designed and implemented YES Health. Nonetheless, the inability to engage PCPs in collaborative interactions likely contributed to YES Health having no effect. Future research should consider approaches toward developing effective patient-physician partnerships to improve care. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: This study may have limited generalizability beyond the context of dually eligible individuals aged <65 years in integrated care delivery systems with dually capitated reimbursement.
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