Slide 1: University of Massachusetts Medical School Commonwealth Medicine
One Care
MassHealth + Medicare

Findings from 2017-2019 One Care Disenrollment Survey
February 2021

Presented by:
Linda Long-Bellil, PhD, JD
Yara Halasa-Rappel, DMD, PhD
Bernadette Shaw, MPH
Ying (Elaine) Wang, PhD

Note: This footer appears on each of the following slides. “© 2021. The consulting and operations division of UMass Medical School. Confidential “
Slide 2: Who We Are
Founded in 1999, Commonwealth Medicine is the health care consulting and operations division of UMass Medical School.

We work with you to enhance the effectiveness of health and human service programs 
to improve outcomes for vulnerable populations.

Our comprehensive suite of health care solutions supports program integrity, improves member health, enhances public programs and fosters a high-quality delivery system. 

Our highly skilled professionals and health care subject matter experts are carefully matched to project goals and client needs. 

The value of our mission as one of the nation’s top medical schools is our commitment to reinvest revenue to advance research and prepare the next generation of health care providers.

We have real-time access to the latest academic research and clinical advancements in development at UMass Medical School.
Slide 3: Research Question and Domains

Research Question
•	Why did former One Care members voluntarily disenroll after receiving care from One Care?
Domains
•	Experiences with members of the Care Team
•	Experiences with getting medical services
•	Experiences with getting Long-Term Services and Supports (LTSS)
•	Experiences and overall satisfaction with care under MassHealth/Medicare FFS as compared to One Care
Slide 4: Survey Sample
•	Random sample drawn from former One Care members who had voluntarily disenrolled
•	Results do not reflect the experiences and perspectives of members of the broader One Care population 
Slide 5: Survey Methodology

•	Survey administered annually between March and May in years 2017-2019
•	Two-wave mail protocol with up to 5 telephone follow-ups for non-respondents
•	Survey response rates
o	2017 - 24% (n=272)
o	2018 - 27% (n=239)
o	2019 - 31% (n=182)
Slide 6: Overview
•	Access to Primary Care Providers
•	Utilization of Care Coordinators in all three years. 
•	Utilization of LTS Coordinators 
•	Difficulties with access to specialty, including mental health and dental services 
•	Difficulties with access to transportation to or help doing things in the community or with everyday tasks in the home.
Slide 7: Limitations
•	The data is based upon self-report and so may be biased by issues with recall and similar concerns
•	The sample sizes were relatively small, particularly when broken down into subcategories which may affect the generalizability of results

Section Slide 8: Experience with The Care Team
No data on this slide
Slide 9: Voluntary Disenrollees’ Experience with PCP
Over 70% of former One Care members had a primary care provider (PCP) while in One Care. There were no statistically significant differences between the studied years. 

The percentage of respondents who voluntarily disenrolled reported they were never able to get a PCP increased over the three survey years, but the change was not significant. 
			
Had a Primary Care Provider While in One Care
•	2017				
o	Yes=74%	
o	No=21%
o	Don’t know/not sure=5%
•	2018
o	Yes=72%
o	No=73%
o	Don’t Know/not sure=5%
•	2019
o	Yes=73%
o	No=20%
o	Don’t know/not sure=8%
•	Sig. Difference
o	p-value
•	0.7556
Did you leave One Care because you were never able to get a PCP?
•	2017
o	Yes=31%
o	No=69%
•	2018
o	Yes=36%
o	No=64%
•	2019
o	Yes=52%
o	No=48%
•	Sig. Difference
o	p-value
•	0.0705

* Significant difference between years indicated by * p<.05, ** p<0.01, *** p<0.001, **** p<0.0001
Slide 10: Voluntary Disenrollees’ Satisfaction with PCP
The majority (81%-82%) of former members who had a PCP were extremely or somewhat satisfied with their providers over the three years of the survey. 

Note:  the following statistics were shown on a bar chart on this slide.

2017
o	Extremely satisfied=61%
o	Somewhat satisfied=20%
o	Somewhat dissatisfied=7%
o	Extremely dissatisfied=12%

2018
o	Extremely satisfied=56%
o	Somewhat satisfied=25%
o	Somewhat dissatisfied=8%
o	Extremely dissatisfied=10%

2019
o	Extremely satisfied=57%
o	Somewhat satisfied=25%
o	Somewhat dissatisfied=10%
o	Extremely dissatisfied=9%
Slide 11: Voluntary Disenrollees’ Reasons for Leaving One Care - PCP
Among members who had a PCP, the most common reason cited for voluntarily disenrolling was not being able to keep the PCP that they had before enrolling in One Care.

The second most common reason for voluntarily disenrolling was not getting the PCP they wanted.

Note:  the following statistics were shown on a bar chart on this slide.

2017
•	Wasn’t able to keep the PCP I had before=39%
•	Did not get PCP I wanted=34%
•	PCP did not understand my needs=22%
•	Difficult to get appointment with PCP=18%
•	PCP did not treat me with respect=13%
•	PCP did not communicate in ways I understood=12%
•	PCP did not speak my preferred language=10%
•	Other reason related to PCP=28%
2018
•	Wasn’t able to keep the PCP I had before=31%	29%
•	Did not get PCP I wanted=28%	28%
•	PCP did not understand my needs=26%	19%
•	Difficult to get appointment with PCP=23%	14%
•	PCP did not treat me with respect=19%	12%
•	PCP did not communicate in ways I understood=19%	11%
•	PCP did not speak my preferred language=18%	11%
•	Other reason related to PCP=26%	31%
2019
•	Wasn’t able to keep the PCP I had before=29%
•	Did not get PCP I wanted=28%
•	PCP did not understand my needs=19%
•	Difficult to get appointment with PCP=14%
•	PCP did not treat me with respect=12%
•	PCP did not communicate in ways I understood=11%
•	PCP did not speak my preferred language=11%
•	Other reason related to PCP=31%

*Sample includes only respondents who had a PCP
† Respondents can choose more than one answer.

Slide 12: Voluntary Disenrollees’ Experiences with Care Coordinator

Throughout the three survey years, only about half of respondents who voluntarily disenrolled reported that they had a Care Coordinator.

The percentage of former members who said they left One Care because they were not able to get a Care Coordinator increased significantly over time.

Had a Care Coordinator While in One Care
2017
•	Yes=48%	
•	No=39% 
•	Don’t know/not sure=13% 
2018	
•	Yes=48%
•	No=40% 
•	Don’t know/not sure=12 
2019
•	Yes=52%
•	No=35% 
•	Don’t know/not sure=14% 
Sig. Difference
•	p-value
•	0.8163
Did you leave One Care because you were never able to get a Care Coordinator?
2017
•	Yes=18%
•	No=82%
2018
•	Yes=11%
•	No=89%
2019
•	Yes=26%	
•	No=74%
Sig. Difference
•	p-value
•	0.0441*
*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001

Slide 13: Voluntary Disenrollees’ Satisfaction with Care Coordinator

Among voluntary disenrolled respondents who reported having a Care Coordinator, satisfaction fluctuated over the three years of the survey, but this change was not statistically significant.

Note: the following statistics were shown in a bar chart on this slide.

2017
•	Extremely satisfied=49%
•	Somewhat satisfied	=25%
•	Somewhat dissatisfied=11%
•	Extremely dissatisfied=16%
2018
•	Extremely satisfied=41%
•	Somewhat satisfied	=42%
•	Somewhat dissatisfied=3%
•	Extremely dissatisfied=14%

2019
•	Extremely satisfied=52%
•	Somewhat satisfied	=23%
•	Somewhat dissatisfied=10%
•	Extremely dissatisfied=15%
Slide 14: Voluntary Disenrollees’ Reasons for Leaving One Care - Care Coordinator
Among former members who had a Care Coordinator, the most common Care Coordinator-related reasons cited for voluntarily disenrolling were that the Care Coordinator did not help get needed services, was not in touch often enough and did not understand the member’s needs. 

Note: the following statistics were shown in a bar chart on this slide.
2017
•	Coordinator did not help me get needed services=26%
•	Coordinator was not in touch with me often enough=22%
•	Coordinator did not understand my needs=23%
•	It was difficult to reach Coordinator=20%
•	Coordinator did not treat me with respect=16%
•	Coordinator did not communicate in ways I understood=15%
•	Coordinator did not speak my preferred language=9%
•	Other reasons related to care coordinator=31%
2018
•	Coordinator did not help me get needed services=21%
•	Coordinator was not in touch with me often enough=17%
•	Coordinator did not understand my needs=20%
•	It was difficult to reach Coordinator=25%
•	Coordinator did not treat me with respect=13%
•	Coordinator did not communicate in ways I understood=13%
•	Coordinator did not speak my preferred language=9%
•	Other reasons related to care coordinator=17%
2019
•	Coordinator did not help me get needed services=29%
•	Coordinator was not in touch with me often enough=26%
•	Coordinator did not understand my needs=21%
•	It was difficult to reach Coordinator=20%
•	Coordinator did not treat me with respect=14%
•	Coordinator did not communicate in ways I understood=13%
•	Coordinator did not speak my preferred language=8%
•	Other reasons related to care coordinator=31%

*Sample includes only respondents who had a Care Coordinator
Ϯ Respondents can choose more than one answer.

Slide 15: Voluntary Disenrollees’ Experiences with LTS Coordinator

About one in five former members had a LTS Coordinator and this percentage fell significantly over the three years of the survey.

However, getting a LTS Coordinator was not a key factor in most respondents’ decisions to voluntarily disenroll from One Care.

Had a LTS While in One Care
2017
•	Yes=20%
•	No=62% 
•	Don’t know/not sure=18% 
2018
•	Yes=15%
•	No=75%	 
•	Don’t know/not sure=11%
2019
•	Yes=15%
•	No=73%	 
•	Don’t know/not sure=12%
Sig. Difference
•	p-value
o	0.0454*
Did you leave One Care because you were never able to get a LTS Coordinator?
2017
•	Yes=15%
•	No=88%
2018
•	Yes=12%
•	No=88%
2019
•	Yes=16%
•	No=84%
Sig. Difference 
•	p-value
o	0.5971

*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001
Slide 16: Voluntary Disenrollees’ Satisfaction with LTS Coordinator
Most former members who had a LTS Coordinator were satisfied with their LTS Coordinators and the percentage who were extremely satisfied increased significantly over time. 

Note: the following statistics were shown in a bar chart on this slide.

2017
•	Extremely satisfied=48%
•	Somewhat satisfied	=37%
•	Somewhat dissatisfied=4%
•	Extremely dissatisfied=11%

2018
•	Extremely satisfied=66%
•	Somewhat satisfied	=28%
•	Somewhat dissatisfied=3%
•	Extremely dissatisfied=3%
2019
•	Extremely satisfied=68%
•	Somewhat satisfied=5%
•	Somewhat dissatisfied=14%
•	Extremely dissatisfied=14%
Slide 17: Voluntary Disenrollees’ Reasons for Leaving One Care – LTS Coordinator 
Among former members with a LTS Coordinator, the main LTS Coordinator-related reasons cited for leaving One Care were that the LTS Coordinator did not understand the former members’ needs, did not help get needed services and were not in touch often enough 

Note: the following statistics were shown in a bar chart on this slide.

2017
•	Coordinator was not in touch with me often enough=23%
•	It was difficult to reach Coordinator=22%
•	Coordinator did not help me get needed services=30%
•	Coordinator did not understand my needs=36%
•	Coordinator did not communicate in ways I understood=16%
•	Coordinator did not treat me with respect=23%
•	Coordinator did not speak my preferred language=9%
•	Other reason related to care coordinator=20%
2018
•	Coordinator was not in touch with me often enough=22%
•	It was difficult to reach Coordinator=22%
•	Coordinator did not help me get needed services=37%
•	Coordinator did not understand my needs=41%
•	Coordinator did not communicate in ways I understood=37%
•	Coordinator did not treat me with respect=19%
•	Coordinator did not speak my preferred language=22%
•	Other reason related to care coordinator=19%
2019
•	Coordinator was not in touch with me often enough=26%
•	It was difficult to reach Coordinator=17%
•	Coordinator did not help me get needed services=17%
•	Coordinator did not understand my needs=13%
•	Coordinator did not communicate in ways I understood=9%
•	Coordinator did not treat me with respect=9%
•	Coordinator did not speak my preferred language=9%
•	Other reason related to care coordinator=32%

*Sample includes only respondents who had a LTS Coordinator
† Respondents can choose more than one answer
Section Slide 18: Medical Services
No data on this slide
Slide 19: Voluntary Disenrollees’ Reasons for Leaving One Care - Medical Services
Difficulties in getting specialist services, oral/dental care, mental health services and prescription medications were the most frequently cited reasons for voluntarily disenrolling that were related to medical services.

Note: the following statistics were shown in a bar chart on this slide.

2017
•	Specialist services=33%
•	Oral/dental care services=31%
•	Prescription medication=22%
•	Mental health services=18%
•	Transportation to medical appointments=20%
•	Physical, occupational or speech therapy services=13%
•	Substance use treatment=7%
•	Other reason related to care coordinator=30%
2018
•	Specialist services=43%
•	Oral/dental care services=22%
•	Prescription medication=27%
•	Mental health services=27%
•	Transportation to medical appointments=13%
•	Physical, occupational or speech therapy services=16%
•	Substance use treatment=7%
•	Other reason related to care coordinator=30%
2019
•	Specialist services=36%
•	Oral/dental care services=30%
•	Prescription medication=26%
•	Mental health services=25%
•	Transportation to medical appointments=20%
•	Physical, occupational or speech therapy services=17%
•	Substance use treatment=7%
•	Other reason related to care coordinator=40%

*Respondents can choose more than one answer.
Section Slide 20: Long-Term Services & Supports
No data on slide
Slide 21: Voluntary Disenrollees Who Received LTSS  
About one in four former One Care members who’ve voluntarily disenrolled received LTSS over the three years of the survey. Any changes were not significant. 

Got Long Term Services and Supports in One Care

2017
•	Yes=27%
•	No=61% 
•	Don’t know/not sure/refused/missing=12%
2018
•	Yes=18%
•	No=71%
•	Don’t know/not sure/refused/missing=11%
2019
•	Yes=24%
•	No=63%
•	Don’t know/not sure/refused/missing=12%

Sig. Difference
•	p-value
o	 0.3052*

*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001

Slide 22: Voluntary Disenrollees’ LTSS-Related Reasons for Leaving One Care 
The primary LTSS-related reasons for voluntarily disenrolling were difficulties getting transportation and difficulties getting help doing things in the community or with everyday tasks in the home. None of these changes over time were statistically significant.

Note: the following statistics were shown in a bar chart on this slide.

2017
•	Transportation to places in the community=13%
•	Help with everyday tasks in home=14%
•	Help doing things in community=12%
•	Nursing services in home=13%
•	Help to participate in day program services=9%
•	Couldn’t get services unless I moved=7%
•	Medical equipment=11%
•	Medical supplies=9%
•	Help with personal care=12%
•	Assistive technology=7%
•	Other reason related to LTSS=18%
2018
•	Transportation to places in the community=11%
•	Help with everyday tasks in home=11%
•	Help doing things in community=11%
•	Nursing services in home=13%
•	Help to participate in day program services=10%
•	Couldn’t get services unless I moved=9%
•	Medical equipment=10%
•	Medical supplies=12%
•	Help with personal care=10%
•	Assistive technology=7%
•	Other reason related to LTSS=14%
2019
•	Transportation to places in the community=22%
•	Help with everyday tasks in home=17%
•	Help doing things in community=17%
•	Nursing services in home=14%
•	Help to participate in day program services=14%
•	Couldn’t get services unless I moved=13%
•	Medical equipment=12%
•	Medical supplies=10%
•	Help with personal care=9%
•	Assistive technology=9%
•	Other reason related to LTSS=23%

*Respondents can choose more than one answer.

Section Slide 23: Enrollment Method
No data on this slide
Slide 24: Voluntary Disenrollees’ Reasons for Leaving One Care - PCP
The percentage of self-selected former members who left One Care because they could not get a PCP fell significantly over the three survey years. The percentage of passive and unsure enrollees increased, but the change was not significant.

Left Because Could Not Get PCP
2017
•	Self-Selected=45%
•	Passive=32%
•	Don’t Know/Not Sure/Other=14%
2018
•	Self-Selected=22%
•	Passive=35%
•	Don’t Know/Not Sure/Other=17%
2019
•	Self-Selected=20%
•	Passive=40%
•	Don’t Know/Not Sure/Other=40%
Sig. Difference
•	p-value
o	Self-Selected=0.0023**
o	Passive=0.6777
o	Don’t Know/Not Sure/Other=NA

*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001
Slide 25: Disenrollees – Difficulties Accessing Mental Health Services
The percentage of voluntary disenrollments for members who were passively enrolled left One Care because they had difficulties obtaining mental health services increased significantly over the three survey years. The percentage of self-selected voluntary disenrollees increased, but the change was not significant.

Mental Health Services
2017
•	Self-Selected=22%
•	Passive=17%
•	Don’t Know/Not Sure/Other=11%
2018
•	Self-Selected=30%
•	Passive=26%
•	Don’t Know/Not Sure/Other=0%
2019
•	Self-Selected=17%
•	Passive=37%
•	Don’t Know/Not Sure/Other=13%
Sig. Difference
•	p-value
o	Self-Selected=0.1234
o	Passive=.015*
o	Don’t Know/Not Sure/Other=NA

*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001

† We also examined changes over time for specialty, mental health, dental, PCA, services along with medications and medical equipment and supplies, but the results were not significant.
Slide 26: Voluntary Disenrollees  - Difficulties Accessing LTSS
The percentage of voluntary disenrollments for members who were passively enrolled left One Care because they had difficulties accessing transportation, day program services or increased significantly.
The percentage of self-selected and unsure respondents increased, but the change was not significant.
Transportation to Community
2017
•	Self-Selected=17%
•	Passive=10%
•	Don’t Know/Not Sure=12%
2018
•	Self-Selected=19%
•	Passive=11%
•	Don’t Know/Not Sure=33%
2019
•	Self-Selected=10%
•	Passive=28%
•	Don’t Know/Not Sure=0%
Sig. Difference
•	p-value
o	Self-Selected=0.2391
o	Passive=0.0043*
o	Don’t Know/Not Sure=NA

Day Program Services
2017
•	Self-Selected=16%
•	Passive=5%
•	Don’t Know/Not Sure=4%
2018
•	Self-Selected=10%
•	Passive=11%
•	Don’t Know/Not Sure=17%
2019
•	Self-Selected=9%
•	Passive=19%
•	Don’t Know/Not Sure=17%
Sig. Difference
•	p-value
o	Self-Selected=0.3634
o	Passive=0.0138*
o	Don’t Know/Not Sure=NA

Couldn’t get LTSS unless I moved
2017
•	Self-Selected=12%
•	Passive=6%
•	Don’t Know/Not Sure=0%
2018
•	Self-Selected=11%
•	Passive=8%
•	Don’t Know/Not Sure=0%
2019
•	Self-Selected=11%
•	Passive=17%
•	Don’t Know/Not Sure=14%
Sig. Difference
•	p-value
o	Self-Selected=0.9725
o	Passive=0.0416*
o	Don’t Know/Not Sure=NA

*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001
Section Slide 27: Enrollment Duration
No data on this slide
Slide 28: Voluntary Disenrollees’ Related Reasons for Leaving One Care - PCP
The percentage of former members who left because they could not get a PCP after only 1-3 months increased significantly over the three survey years. 
The percentage who left because they did not get the PCP they wanted also changed significantly between the 2017-2019 surveys. 

2017 
Left Because Could Not Get PCP
•	1-3 months=30%
•	3-12 months=29%
•	More than a year=33%
Left Because Did Not Get PCP I Wanted
•	1-3 months=30%
•	3-12 months=29%
•	More than a year=21%
2018
Left Because Could Not Get PCP
•	1-3 months=42%
•	3-12 months=26%
•	More than a year=50%
Left Because Did Not Get PCP I Wanted
•	1-3 months=42%
•	3-12 months=26%
•	More than a year=36%
2019
Left Because Could Not Get PCP
•	1-3 months=67%
•	3-12 months=39%
•	More than a year=50%
Left Because Did Not Get PCP I Wanted
•	1-3 months=67%
•	3-12 months=39%
•	More than a year=22%
Sig. Difference
•	p-value
o	1-3 months=0.0479*
o	3-12 months=0.6627
o	More than a year=0.2153

*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001
Slide 29: Voluntary Disenrollees - Difficulties Accessing Services
The percentage of former members who left because they had difficulties accessing oral/dental care services after being enrolled for 3-12 months increased significantly over the three survey years.

2017
Oral/Dental Care Services
•	1-3 months=23%
•	3-12 months=32%
•	More than a year=36%
2018
Oral/Dental Care Services
•	1-3 months=14%
•	3-12 months=19%
•	More than a year=43%
2019
Oral/Dental Care Services
•	1-3 months=20%
•	3-12 months=39%
•	More than a year=25%
Sig. Difference
•	p-value
o	Oral/Dental Care Services
•	1-3 months=0.4110
•	3-12 months=0.0206*
•	More than a year=0.2115
*Significant difference between years indicated by *p<.05, **p<.01, ***p<.001, ****p<.0001

Section Slide 30: Main Reason for Disenrolling
No data on this slide
Slide 31: Voluntary Disenrollees’ Main Reasons for Leaving One Care
Inability to keep Primary Care Provider – 25%
•	“My PCP did not accept that insurance.”
•	“My PCP of over 20 years was not covered.”
•	“Not enough PCPs in my area.”
Inability to stay with Specialists/Hospital/Clinic – 19% 
•	“Because my neurosurgeon did not accept CC as I was going to have spine surgery.”
•	“I had an infectious disease doctor and primary care as one for 15-20 years then when One Care terminated that after so many years, I trust him, and we work well together.”
•	“I have very good cancer doctors and won’t switch (eyes, teeth, primary was optional) One Care didn’t take any of my doctors.”
•	“I left because of my mental health, I did not want to change psychiatrist or psychologist.” 
Slide 32: Voluntary Disenrollees’ Main Reasons for Leaving One Care
Lack of Coverage for Needed Services – 15%
•	“The plan didn’t fit my needs.”
•	“One Care could not provide adequate transportation to his daily program. They were not door to door.”
Administrative Issues – 6%  
•	“Because you are so disorganized, and nobody knew what they were doing when I called.”
•	“I didn’t want to leave One Care, I liked One Care a lot but getting ahold of a case manager or nurse was terrible.”
•	“I was getting too much correspondence with them.”
•	“The customer service people were always confused and made many mistakes. My One Care ID was issued twice and both times it was wrong. Help was never available.” 
Slide 33: Voluntary Disenrollees’ Main Reasons for Leaving One Care
Dissatisfaction with Prescription Drug Coverage – 5%
•	“My prescription drugs were being denied. It was a hassle to get prescriptions approved.”
•	“They did not cover medications that I have been on for most of life.”
•	“I left One Care because they charged a lot of copay for my medications and MassHealth does not charge.”
Dissatisfaction with Available Dental Care – 4% 
•	“My dental was not covered.”
•	“I was losing services that I needed such as dental and eye care.”
•	“I left One Care because it was bad for the dentist.”
Dissatisfaction with Available Mental Health Care – 3%
•	“One Care didn't cover my psychiatry appointments.”
•	“I could not find an outpatient therapist that was a good fit. . . .I wish I was given more support around it and it never happened.”

Section Slide 34: One Care Compared to MassHealth/Medicare FFS
No data on this slide
Slide 35: Voluntary Disenrollees - Medical and LTSS Services Needed/Used
Medications, specialty and dental care were the three services most frequently needed or used by former One Care members during all three years 

Note: the following statistics were shown in a bar chart on this slide.

2017
•	Specialist=75%
•	Mental Health=56%
•	Dental care=78%
•	Medications=95%
•	Personal care=30%
•	Equipment=31%
2018
•	Specialist=74%
•	Mental Health=54%
•	Dental care=73%
•	Medications=93%
•	Personal care=27%
•	Equipment=29%
2019
•	Specialist=76%
•	Mental Health=57%
•	Dental care=79%
•	Medications=95%
•	Personal care=29%
•	Equipment=32%
Slide 36: Experiences of Voluntary Disenrollees in FFS vs. One Care
The percent of former members who said that specialty care in FFS was much or somewhat better than in One Care increased over the three survey years but was not statistically significant. 

The percent of former members who said that FFS mental health was much or somewhat better declined but was not significant. 

The percent who of former members said that dental services in FFS were better than in One Care for declined significantly over time.

Note: the following statistics were shown in a bar chart on this slide.

Specialist
2017
Much better=46%
A little better=12%
About the same=33%
A little worse=6%
Much worse=3%
2018
Much better=48%
A little better=13%
About the same=32%
A little worse=4%
Much worse=3%
2019
Much better=58%
A little better=10%
About the same=21%
A little worse=6%
Much worse=4%

Mental health
2017
Much better=46%
A little better=11%
About the same=35%
A little worse=5%
Much worse=3%
2018
Much better=46%
A little better=8%
About the same=39%
A little worse=6%
Much worse=2%
2019
Much better=39%
A little better=9%
About the same=38%
A little worse=6%
Much worse=9%

Dental Care
2017
Much better=38%
A little better=14%
About the same=31%
A little worse=6%
Much worse=11%
2018
Much better=35%
A little better=12%
About the same=40%
A little worse=7%
Much worse=6%
2019
Much better=35%
A little better=4%
About the same=48%
A little worse=7%
Much worse=12%
Slide 37: Experiences of Voluntary Disenrollees in FFS vs. One Care 
The percent of former members who said that care pertaining to medications, Personal Care Assistant services, medical equipment and supplies was much better or a little better in MassHealth/Medicare FFS than in One Care decreased over the three survey years, but these changes were not significant.

Note: the following statistics were shown in a bar chart on this slide.

Medication
2017
Much better=39%
A little better=12%
About the same=33%
A little worse=10%
Much worse=5%
2018
Much better=38%
A little better=11%
About the same=35%
A little worse=12%
Much worse=4%
2019
Much better=32%
A little better=12%
About the same=42%
A little worse=6%
Much worse=8%

PCA
2017
Much better=42%
A little better=14%
About the same=29%
A little worse=9%
Much worse=8%
2018
Much better=42%
A little better=10%
About the same=38%
A little worse=2%
Much worse=8%
2019
Much better=38%
A little better=8%
About the same=28%
A little worse=10%
Much worse=15%

Supplies
2017
Much better=31%
A little better=14%
About the same=41%
A little worse=6%
Much worse=8%
2018
Much better=28%
A little better=16%
About the same=46%
A little worse=5%
Much worse=5%
2019
Much better=31%
A little better=7%
About the same=45%
A little worse=12%
Much worse=5%

Slide 38: Overall Satisfaction of Voluntary Disenrollees - FFS vs One Care

The percentage former members that were extremely or somewhat satisfied with FFS remained consistently high with 87%-89% saying that they were extremely or somewhat satisfied with MassHealth/Medicare FFS.

In contrast, only 54%-58% of former members were consistently extremely or somewhat satisfied with One Care over the three survey years. 
Many fewer former members said that they were extremely satisfied with One Care than with FFS.

Note: the following statistics were shown in a bar chart on this slide.

2017
One Care
Extremely satisfied=23%
Somewhat satisfied=31%
Somewhat dissatisfied=19%
Extremely dissatisfied=27%
FFS
Extremely satisfied=50%
Somewhat satisfied=38%
Somewhat dissatisfied=7%
Extremely dissatisfied=5%

2018
One Care
Extremely satisfied=27%
Somewhat satisfied=31%
Somewhat dissatisfied=20%
Extremely dissatisfied=22%
FFS
Extremely satisfied=53%
Somewhat satisfied=36%
Somewhat dissatisfied=8%
Extremely dissatisfied=3%

2019
One Care
Extremely satisfied=30%
Somewhat satisfied=26%
Somewhat dissatisfied=19%
Extremely dissatisfied=25%
FFS
Extremely satisfied=48%
Somewhat satisfied=39%
Somewhat dissatisfied=8%
Extremely dissatisfied=5%
Slide 39: Conclusions
•	The primary reason that people voluntarily disenrolled from One Care was that they could not keep their PCP, specialist, or mental health provider.
•	Only about half of former members reported having a Care Coordinator in all three years. Those with Care Coordinators were satisfied, but about a quarter left due to dissatisfaction with Care Coordinators.
•	Utilization of LTS Coordinators was consistently low from 2017-2019 for former members, although most with a LTS Coordinator were satisfied.
•	Difficulties with access to specialty and dental services were the main medical service-related reasons for voluntarily disenrolling.
•	The primary LTSS-related reasons for disenrolling were difficulties getting transportation or help doing things in the community or with everyday tasks in the home.
Slide 40: Contacts
Linda Long-Bellil, PhD, JD
Research & Evaluation
linda.long@umassmed.edu 
508-856-8417

Yara Halasa-Rappel, DMD, PhD
Research & Evaluation
yara.halasa@umassmed.edu 
781-330-9015

Ying (Elaine) Wang, PhD
Research & Evaluation
ying.wang@umassmed.edu 
Phone

Commonwealth Medicine
University of Massachusetts Medical School
333 South Street, Shrewsbury, MA, 01545
Section Slide 41: Appendix
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Section Slide 42: One Care 2019 Disenrollment Survey
No data on this slide
Slides 43-54: One Care 2019 Disenrollment Survey
Note: slides 43-54 contain the pages of the survey