Slide 1: Findings from the One Care Quality of Life Surveys 2019-2022
ForHealth Consulting at UMass Chan Medical School

May 2024

Present to: (The Massachusetts state seal is shown here.)

Presented by: 
Yara Halasa-Rappel, PhD, DMD
Linda Long-Bellil, PhD, JD
Jianying Zhang, MPH, MD
Ying (Elaine) Wang, PhD
Slide 2:Research Questions
Note:  The ForHealth Consulting logo and the following footnote is shown on this slide and all slides going forward. 
“© 2024. The consulting and operations division of UMass Chan Medical School. Confidential”
Slide 3: Research Questions 
1.	Is there a change over time in dual-eligible members’ perceptions of their overall physical health, mental and emotional health, and overall life satisfaction?
2.	What is the association between members’ demographics, reported disabilities, and residents and members’ perceptions of their overall physical health, mental and emotional health, and overall life satisfaction?

3.	What is the association between members’ need for help doing day-to-day activities and doing things in the community and members’ rating of their overall physical, mental, and emotional health and life satisfaction?
4.	Based on the data collected in the Quality of Life survey, what factors would improve members' ratings of their overall physical, mental, and emotional health and overall life satisfaction? 
Slide 4: Methodology
Title slide only, no content on this slide.
Slide 5: Survey Implementation
The survey was administered annually in English and Spanish between the months of January through May.
•	Two-wave mail survey
•	Five telephone follow-ups

Note:  The following data is shown in a table on this slide.

QoL survey (Reference Year) 	2019
Data collection (Year) 	2020

QoL survey (Reference Year) 	2020
Data collection (Year) 	2021

QoL survey (Reference Year) 	2021
Data collection (Year) 	2022

QoL survey (Reference Year) 	2022
Data collection (Year) 	2023
Slide 6: Methodology - Change Over Time
•	Combined One Care and FFS data from 2019 through 2022 
To generalize the findings, the results were adjusted using two weights: 
o	(1) non-response, and 
o	(2) the study sample to population weight
•	Respondents’ characteristics were different over the four survey years. To be able to compare the results over time, we controlled for these characteristics using ordered or multinomial regression analyses.
•	The predicted values from those regressions were used to answer the four research questions
Slide 7: Association
Note: The following bullet points are shown in four blocks with the first two blocks beside each other with an arrow pointing from the block on the left to the block on the right showing the relationship from one to the other. The third and fourth blocks are below these and are shown in the same format.

Tested the association between:

•	Rating of overall physical health
•	Rating of mental and emotional
•	Rating of overall life satisfaction

•	Members’ demographics
•	Members’ residency
•	Members’ disability status

•	Help doing day-to-day activity
•	Help doing things in the community

•	Rating of overall physical health
•	Rating of mental and emotional
•	Rating of overall life satisfaction

Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language, region, and number of disabilities
Slide 8: Statements about Member’s Health and Well-Being
We asked members to respond to the following questions using a 5-point Likert scale with the following response options:

1)	Strongly agree
2)	Agree
3)	Not sure
4)	disagree
5)	Strongly disagree

Statements about Your Health and Well-Being 

Note: the following statements are shown in a table with two columns on this slide.

Column 1:
I live my life to the fullest
I can easily get the medical services I need 
I eat nutritious meals every day
I enjoy life
I have an upbeat and positive attitude 
I need help in getting around
I can easily get the transportation I need to get around 
My spirituality or religious faith is an important part of my life 
I am in control of my life 
My home has everything I need to live comfortably 
My everyday tasks get done
I have friends I can count on 
I often feel lonely

Column 2:
I feel energetic through the day
I have difficulty concentrating 
I would like more support from other people 
I feel low on a regular basis, such as feeling blue, despair, anxiety or depression 
I frequently forget where I put things 
I am capable of working
I get together with people on a regular basis 
I feel safe where I live 
I have difficulty performing my daily tasks
My life has purpose 
I feel good about myself 
I feel confident about the decisions I make 
I have good relationships with my health care and other providers 
Slide 9: Factors Affecting Members’ Well-being

•	Created a binary good/fair variables from members’ rating of their physical health, mental and emotional health, and overall life satisfaction 
o	Good = Excellent, very good, good
o	Fair = Fair, poor
•	Combined if members agree or disagree with 26 statements reflecting their overall look on life and well-being
o	Agree = Strongly agree, agree, not sure
o	Disagree = Disagree, strongly disagree
•	Used regression analyses to identify factors that have a significant impact on members’ rating of their physical health, mental and emotional health, and overall life satisfaction 
•	Computed the potential incremental impact of a change in members’ status on members’ rating of their physical health, mental and emotional health, and overall life satisfaction
Slide 10: Results
Title slide only, no content on this slide.
Slide 11: Response Rate
Note:  The following data is shown in a table on this slide.

Survey (Reference Year) 2019
Data collection (Year) 2020
Overall response rate (# of respondents) 38.5% (1,132)
One Care response rate (# of respondents) 38.5% (569)
FFS response rate (# of respondents) 38.6% (563)

Survey (Reference Year) 2020
Data collection (Year) 2021
Overall response rate (# of respondents) 33.0% (970)
One Care response rate (# of respondents) 32.7% (482)
FFS response rate (# of respondents) 33.3% (488)

Survey (Reference Year) 2021
Data collection (Year) 2022
Overall response rate (# of respondents) 32.0% (936)
One Care response rate (# of respondents) 32.3% (474)
FFS response rate (# of respondents) 31.8% (462)

Survey (Reference Year) 2022
Data collection (Year) 2023
Overall response rate (# of respondents) 32.7% (958)
One Care response rate (# of respondents) 33.1% (485)
FFS response rate (# of respondents) 32.3% (473)
Slide 12: Q1.
Is there a change over time in dual-eligible members’ perceptions of their overall physical health, mental and emotional health, and overall life satisfaction?
Slide 13: Overall Physical Health
Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities

•	47% of One Care members and 45% of FFS members reported being in excellent, very good, or good health. However, those differences were not statistically significant.

Note: The following data is shown in bar graphs on this slide.

One Care
Excellent	4%
Very Good	11%
Good	33%
Fair	39%
Poor	14%

FFS
Excellent	3%
Very Good	10%
Good	32%
Fair	40%
Poor	15%
Slide 14: Overall Physical Health
Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities

•	Across the four survey years (2019-2022), One Care members rated their overall physical health slightly better than FFS members. However, those differences were not statistically significant.

Note: the following data is shown in bar graphs on this slide.

One Care

2019
Excellent	4%
Very Good	11%
Good	33%
Fair	38%
Poor	13%

2020
Excellent	4%
Very Good	10%
Good	32%
Fair	40%
Poor	15%

2021
Excellent	4%
Very Good	11%
Good	33%
Fair	39%
Poor	14%

2022
Excellent	4%
Very Good	11%
Good	32%
Fair	39%
Poor	14%

FFS

2019
Excellent	4%
Very Good	11%
Good	32%
Fair	39%
Poor	14%

2020
Excellent	3%
Very Good	9%
Good	31%
Fair	40%
Poor	16%

2021
Excellent	4%
Very Good	10%
Good	32%
Fair	39%
Poor	15%

2022
Excellent	3%
Very Good	10%
Good	31%
Fair	40%
Poor	15%

Slide 15: Mental and Emotional Health
Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities.

•	55% of One Care members and 54% of FFS members reported being in excellent, very good, or good mental and emotional health. However, those differences were not statistically significant.

Note: The following data is shown in bar graphs on this slide.

One Care
Excellent	8%
Very Good	14%
Good	33%
Fair	35%
Poor	10%

FFS
Excellent	8%
Very Good	14%
Good	33%
Fair	35%
Poor	10%
Slide 16	: Mental and Emotional Health
Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities.

•	Across the four survey years (2019-2022), One Care members rated their mental and emotional health slightly better than FFS members. However, those differences were not statistically significant.

Note: The following data is shown in bar graphs on this slide.

One Care

2019
Excellent	8%
Very Good	15%
Good	34%
Fair	34%
Poor	9%

2020
Excellent	8%
Very Good	14%
Good	33%
Fair	35%
Poor	10%

2021
Excellent	8%
Very Good	14%
Good	33%
Fair	35%
Poor	10%

2022
Excellent	8%
Very Good	14%
Good	33%
Fair	35%
Poor	10%

FFS

2019
Excellent	8%
Very Good	15%
Good	33%
Fair	34%
Poor	10%

2020
Excellent	7%
Very Good	14%
Good	33%
Fair	36%
Poor	11%

2021
Excellent	7%
Very Good	14%
Good	33%
Fair	35%
Poor	10%

2022
Excellent	7%
Very Good	14%
Good	33%
Fair	36%
Poor	11%
Slide 17: Overall Life Satisfaction
Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities. 

•	56% of One Care members were very satisfied (14%) or satisfied (42%) compared to 54% of FFS members. However, those differences were not statistically significant by program or across four survey years (2019-2022).

Note: the following data is shown in bar graphs on this slide.

One Care

2019
Very satisfied	15%
Satisfied	43%
Neither satisfied or not satisfied	24%
Not satisfied	13%
Very dissatisfied	4%

2020
Very satisfied	14%
Satisfied	43%
Neither satisfied or not satisfied	25%
Not satisfied	14%
Very dissatisfied	4%

2021
Very satisfied	13%
Satisfied	42%
Neither satisfied or not satisfied	26%
Not satisfied	15%
Very dissatisfied	4%

2022
Very satisfied	14%
Satisfied	42%
Neither satisfied or not satisfied	25%
Not satisfied	15%
Very dissatisfied	4%

FFS

2019
Very satisfied	14%
Satisfied	42%
Neither satisfied or not satisfied	25%
Not satisfied	14%
Very dissatisfied	4%

2020
Very satisfied	13%
Satisfied	41%
Neither satisfied or not satisfied	26%
Not satisfied	15%
Very dissatisfied	5%

2021
Very satisfied	12%
Satisfied	40%
Neither satisfied or not satisfied	26%
Not satisfied	16%
Very dissatisfied	5%

2022
Very satisfied	13%
Satisfied	41%
Neither satisfied or not satisfied	26%
Not satisfied	16%
Very dissatisfied	5%
Slide 18: Q2.
What is the association between members’ perceptions of their overall physical health, mental and emotional health, and overall life satisfaction and members’ characteristics?
Slide 19: Overall Life Satisfaction: Members’ Characteristics
We found a significant difference in how members rated their overall physical health based on:
•	Region of residence: Members in the Western Region had a significantly lower rating of overall physical health compared to members who reside in other regions
•	Age: Older members (45+ years of age) had a significantly lower rating of overall physical health compared to younger members
•	Race/Ethnicity: Members who identified as Hispanic had a significantly lower rating of overall physical health compared to other race/ethnic groups
•	Language spoken at home: Members who reported speaking a language other than English or Spanish had a significantly lower rating of overall physical health compared to members who speak English or Spanish 
•	Disability Type: Members who reported having a long-term Illness, mental or psychiatric condition, or a problem with alcohol or drug use had a significantly lower rating of overall physical health 
Slide 20: Mental and Emotional Health: Members’ Characteristics
We found a significant difference in how members rated their mental and emotional health based on:
•	Region of residence: Members in the Boston and Western Regions had a significantly lower rating of mental and emotional health compared to members who reside in other regions
•	Race/Ethnicity: Members who identified as Hispanic had a significantly lower rating of mental and emotional health compared to other race/ethnic groups
•	Language spoken at home: Members who reported speaking a language other than English or Spanish had a significantly lower rating of mental and emotional health compared to members who speak English or Spanish
•	Disability Type: Members who reported having a mental or psychiatric condition, or a problem with alcohol or drug use, had a significantly lower rating of overall mental or emotional health
Slide 21: Overall Life Satisfaction:  Members’ Characteristics
We found a significant difference in how members rated their overall life satisfaction based on:
•	Race/Ethnicity: Members identified as White and Other had a significantly lower overall life satisfaction compared to members identified as Hispanic or Black
•	Language spoken at home: Members who reported speaking a language other than English or Spanish had a significantly lower overall life satisfaction compared to members who speak English or Spanish 
•	Disability Type: Members who reported having a mental or psychiatric condition, a problem with alcohol or drug use, or a physical disability had a significantly lower rating of overall life satisfaction
Slide 22: Q3.a.

What is the association between members’ need for help doing day-to-day activities and members’ ratings of their overall physical, mental, and emotional health and life satisfaction?
Slide 23: Help Doing Day-to-Day Tasks at Home

•	Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities:
o	17% of One Care members and 13% of FFS members had a lot of need for help doing day-to-day tasks at home. 
o	30% of One Care and FFS members needed some help.
o	53% of One Care members and 58% of FFS members did not need any help doing day-to-day tasks at home.
•	The percentage of One Care members who reported needing a lot of help doing day-to-day tasks at home was higher than for FFS members, but the differences were not significant between the two programs or across the survey years. 

Note: The following data is shown in bar graphs on this slide.

One Care
A lot	17%
Some	30%
None	53%

FFS
A lot	13%
Some	30%
None	58%

Slide 24: Getting Needed Help at Home with Day-to-Day Tasks: Lots of Needs
•	For those who need a lot of help doing day-to-day tasks at home:
o	70% of One Care members and 65% of FFS members stated their needs were met.
•	95% of both One Care and FFS members in this category reported they were satisfied or very satisfied with the services received.  
o	22% of One Care members and 19% of FFS members stated their needs were somewhat met.  
•	40% of One Care members and 49% of FFS members were satisfied or very satisfied with the services received. 
o	8% of One Care members and 15% of FFS members stated their needs were not met at all.
•	The differences in services received between One Care and FFS members were statistically significant, with more One Care members reporting their needs were met or somewhat met compared to FFS members. 
•	The differences across the four survey years were not statistically significant. 

Note: The following data is shown in bar graphs on this slide.

One Care
Yes	70%
Somewhat	22%
Not at all	8%

FFS
Yes	65%
Somewhat	19%
Not at all	15%
Slide 25: Association between members’ need for help doing day-to-day tasks at home and rating of overall physical health
Members with a lot of needs who received all of the needed help rated their overall physical health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need a lot of help and got the needed help
Excellent	4%
Very Good	7%
Good	22%
Fair	47%
Poor	20%

Need a lot of help and got some of the needed help
Excellent	1%
Very Good	3%
Good	9%
Fair	54%
Poor	34%
Slide 26: Association between members’ need for help doing day-to-day tasks at home and rating of mental and emotional health
Members with a lot of needs who received all of the needed help rated their mental and emotional health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need a lot of help and got the needed help
Excellent	6%
Very Good	11%
Good	41%
Fair	34%
Poor	7%

Need a lot of help and got some of the needed help
Excellent	2%
Very Good	2%
Good	30%
Fair	59%
Poor	8%
Slide 27: Association between members need for help doing day-to-day tasks at home and rating of overall life satisfaction 
Members with a lot of needs who received all of the needed help rated their overall life satisfaction significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need a lot of help and got the needed help
Very satisfied	11%
Satisfied	49%
Neither satisfied or not satisfied	24%
Not satisfied	12%
Very dissatisfied	5%

Need a lot of help and got some of the needed help
Very satisfied	4%
Satisfied	27%
Neither satisfied or not satisfied	31%
Not satisfied	30%
Very dissatisfied	8%
Slide 28: Getting Needed Help at Home with Day-to-Day Tasks: Some Needs
•	For those who need some help doing day-to-day tasks at home:
o	44% of One Care and FFS members stated their needs for help at home with day-to-day tasks were met
•	89% of One Care and 90% of FFS members in this category reported they were satisfied or very satisfied with the services received  
o	38% of One Care members and 37% of FFS members stated their needs were somewhat met  
•	40% of One Care members and 39% of FFS members were satisfied or very satisfied with the services received
o	17% of One Care members and 19% of FFS members stated their needs were not met at all
•	The differences in services received between One Care and FFS members across the four survey years were not statistically significant

Note: The following data is shown in bar graphs on this slide.

One Care
Yes	44%
Somewhat	38%
Not at all	17%

FFS
Yes	44%
Somewhat	37%
Not at all	19%
Slide 29: Association between members’ need for help doing day-to-day tasks at home and rating of overall physical health
Similarly, members with some needs who received all of the needed help rated their overall physical health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need some help and got the needed help
Excellent	2%
Very Good	9%
Good	30%
Fair	48%
Poor	11%

Need some help and got some of the needed help
Excellent	2%
Very Good	4%
Good	24%
Fair	52%
Poor	18%
Slide 30: Association between members’ need for help doing day-to-day tasks at home and rating of mental and emotional health  
Similarly, members with some needs who received the needed help rated their mental and emotional health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need some help and got the needed help
Excellent	3%
Very Good	14%
Good	44%
Fair	31%
Poor	7%

Need some help and got some of the needed help
Excellent	2%
Very Good	8%
Good	35%
Fair	45%
Poor	10%
Slide 31: Association between members need for help doing day-to-day tasks at home and rating of overall life satisfaction 
Similarly, members with some needs who received the needed help rated their overall life satisfaction significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need some help and got the needed help
Very satisfied	14%
Satisfied	51%
Neither satisfied or not satisfied	21%
Not satisfied	14%
Very dissatisfied	0%

Need some help and got some of the needed help
Very satisfied	6%
Satisfied	38%
Neither satisfied or not satisfied	37%
Not satisfied	15%
Very dissatisfied	5%
Slide 32: Help Doing Day-to-Day Tasks at Home 
By Rating Categories (One Care members)
•	Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities:
o	One Care Members in C3A/B category have statistically significant higher needs for help doing day-to-day tasks compared to One Care Members in other rating categories
o	We found no significant differences when it comes to One Care members reporting needing help doing day-to-day tasks at home across the four survey years

Note: The following data is shown in bar graphs on this slide.

A lot of needs
C1	9%
C2A/B	9%
C3A/B	28%

Some needs
C1	31%
C2A/B	27%
C3A/B	37%

None
C1	60%
C2A/B	63%
C3A/B	35%
Slide 33: Getting Needed Help at Home with Day-to-Day Tasks: Lots of Needs
For those who need a lot of help doing day-to-day tasks at home:
•	There was a statistically significant difference in members reporting their needs were met based on their rating category, with the majority of members in rating category C3A/B reporting their needs were met.
•	For members in C3A/B, we found significant differences in members reporting their needs were met. 72% reported their needs were met in 2019, but this percentage decreased in 2020 during the COVID-19 PHE to 65%, yet increased again to 71% in 2022.

Note: The following data is shown in bar graphs on this slide.

Yes
C1	52%
C2A/B	44%
C3A/B	70%

Somewhat
C1	13%
C2A/B	40%
C3A/B	24%

Not at all
C1	34%
C2A/B	15%
C3A/B	6%
Slide 34: Getting Needed Help at Home with Day-to-Day Tasks: Some Needs
For those who need some help doing day-to-day tasks at home:
•	There was no statistically significant difference in members reporting their needs were met based on their rating category or over time.

Note: The following data is shown in bar graphs on this slide.
Yes
C1	42%
C2A/B	37%
C3A/B	44%

Somewhat
C1	45%
C2A/B	35%
C3A/B	39%

Not at all
C1	13%
C2A/B	28%
C3A/B	16%
Slide 35: Q3.b.
What is the association between members’ need for help doing things in the community and members’ ratings of their overall physical, mental, and emotional health and life satisfaction?
Slide 36: Help Doing Things in the Community
•	Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities:
o	23% of One Care members and 20% of dual-eligible members enrolled in the FFS program had a lot of needs for help doing things in the community. 
o	37% of One Care members and 41% of FFS needed some help doing things in the community.
o	40% of One Care members and 39% of FFS members did not need any help doing things in the community. 
•	While the percentage of One Care members who reported needing a lot of help doing things in the community was higher than members in the FFS program, this difference was not significant between the two programs or across the survey years.  

Note: The following data is shown in bar graphs on this slide.

One Care
A lot	23%
Some	37%
None	40%

FFS
A lot	20%
Some	41%
None	39%
Slide 37: Getting Needed Help Doing Things in the Community: Lots of Needs
•	For those who reported a need for a lot of help doing things in the community:
o	52% of One Care members and 48% of FFS members stated their needs were met.
•	91% of both One Care and 94% of FFS members in this category reported they were satisfied or very satisfied with the services received.  
o	22% of One Care members and 28% of FFS members stated their needs were somewhat met.  
•	32% of One Care members and 30% of FFS members were satisfied or very satisfied with the services received. 
o	26% of One Care members and 24% of FFS members stated their needs were not met at all.
•	The differences in services received between One Care and FFS members across the four survey years were not statistically significant.

Note: The following data is shown in bar graphs on this slide.

One Care
Yes	52%
Somewhat	22%
Not at all	26%

FFS
Yes	48%
Somewhat	28%
Not at all	24%

Slide 38: Association between members need help doing things in the community and rating of overall physical health
Members with a lot of needs who received all of the needed help rated their overall physical health similarly to those who received some help.

Note: The following data is shown in bar graphs on this slide.

Need a lot of help and got the needed help
Excellent	3%
Very Good	7%
Good	25%
Fair	45%
Poor	19%

Need a lot of help and got some of the needed help
Excellent	1%
Very Good	11%
Good	24%
Fair	46%
Poor	19%
Slide 39: Association between members need help doing things in the community and rating of mental and emotional health
Members with a lot of needs who received all of the needed help rated their mental and emotional health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need a lot of help and got the needed help
Excellent	4%
Very Good	10%
Good	43%
Fair	36%
Poor	6%

Need a lot of help and got some of the needed help
Excellent	2%
Very Good	7%
Good	41%
Fair	44%
Poor	7%
Slide 40: Association between members need help doing things in the community and rating of overall life satisfaction
Members with a lot of needs who received all of the needed help rated their overall life significantly better than others who received some help.

Note: the following data is shown in bar graphs on this slide.

Need a lot of help and got the needed help
Very satisfied	15%
Satisfied	48%
Neither satisfied or not satisfied	22%
Not satisfied	13%
Very dissatisfied	2%

Need a lot of help and got some of the needed help
Very satisfied	7%
Satisfied	33%
Neither satisfied or not satisfied	30%
Not satisfied	25%
Very dissatisfied	5%
Slide 41: Getting Needed Help Doing Things in the Community: Some Needs
•	For those who needed some help doing things in the community:
o	35% of One Care members and FFS members stated their needs were met.
•	86% of both One Care and FFS members in this category reported they were satisfied or very satisfied with the services received.  
o	44% of One Care members and 40% of FFS members stated their needs were somewhat met. 
•	48% of One Care members and 42% of FFS members were satisfied or very satisfied with the services received. 
o	20% of One Care members and 25% of FFS members stated their needs were not met at all.
•	The differences in services received between One Care and FFS members were not significant.

Note: The following data is shown in bar graphs on this slide.
One Care
Yes	35%
Somewhat	44%
Not at all	20%

FFS
Yes	35%
Somewhat	40%
Not at all	25%
Slide 42: Association between members need help doing things in the community and rating of overall physical health
•	Similarly, members with some needs who received all of the needed help rated their overall physical health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need some help and got the needed help
Excellent	2%
Very Good	6%
Good	37%
Fair	48%
Poor	7%

Need some help and got some of the needed help
Excellent	2%
Very Good	7%
Good	30%
Fair	49%
Poor	13%

Slide 43: Association between members need help doing things in the community and rating of mental and emotional health
Similarly, members with some needs who received all of the needed help rated their mental and emotional health significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need some help and got the needed help
Excellent	4%
Very Good	16%
Good	47%
Fair	29%
Poor	5%

Need some help and got some of the needed help
Excellent	3%
Very Good	9%
Good	34%
Fair	45%
Poor	9%
Slide 44: Association between members need help doing things in the community and rating of overall life satisfaction
•	Similarly, members with some needs who received all of the needed help rated their overall life satisfaction significantly better than others who received some help.

Note: The following data is shown in bar graphs on this slide.

Need some help and got the needed help
Very satisfied	12%
Satisfied	57%
Neither satisfied or not satisfied	22%
Not satisfied	8%
Very dissatisfied	1%

Need some help and got some of the needed help
Very satisfied	6%
Satisfied	40%
Neither satisfied or not satisfied	31%
Not satisfied	18%
Very dissatisfied	4%
Slide 45: Help Doing Things in the Community 
By Rating Categories (One Care members)
Controlling for mental or psychiatric problems, long-term illness, learning disability, visual impairment, age, race/ethnicity, language spoken at home, residency region, and the number of reported disabilities:
•	One Care Members in C3A/B category have statistically significant higher needs for help doing things in the community compared to One Care Members in other rating categories
•	We found no significant differences when it comes to One Care members reporting needing help doing things in the community across the four survey years

Note: The following data is shown in bar graphs on this slide.
A lot of needs
C1	16%
C2A/B	16%
C3A/B	34%

Some needs
C1	38%
C2A/B	38%
C3A/B	41%

None
C1	46%
C2A/B	46%
C3A/B	25%
Slide 46: Getting Needed Help at Home with Day-to-Day Tasks: Lots of Needs
By Rating Categories (One Care members)

For those who need some help doing day-to-day tasks in the community:
•	There were no statically significant differences in members reporting their needs were met for help doing things in the community based on their rating or across time.

Note: The following data is shown in bar graphs on this slide.

Yes
C1	55%
C2A/B	36%
C3A/B	52%

Somewhat
C1	22%
C2A/B	25%
C3A/B	24%

Not at all
C1	23%
C2A/B	38%
C3A/B	24%
Slide 47: Getting Needed Help at Home with Day-to-Day Tasks: Some Needs
By Rating Categories (One Care members)

For those who need some help doing things in the community:
•	There was no statically significant difference in members reporting their needs were met based on their rating category or over time

Note: The following data is shown in bar graphs on this slide.
Yes
C1	36%
C2A/B	32%
C3A/B	31%

Somewhat
C1	46%
C2A/B	43%
C3A/B	45%

Not at all
C1	17%
C2A/B	25%
C3A/B	23%
Slide 48: Q4.
Based on the data collected in the QoL survey, what factors would improve members' ratings of their overall physical, mental, and emotional health and overall life satisfaction?
Slide 49: Improving Rating of Overall Physical
•	Services and activities that engage and empower members and help them perform their daily tasks would improve members’ rating of their overall physical health by 5%, from 44% to 49%.
•	Improving members’ ability to get around would improve members’ rating of their overall physical health by 3%, from 43% to 46%.
•	Services and activities that would help members engage in meaningful work would improve members’ rating of their overall physical health by 1%, from 43% to 44%.
•	Reducing members’ needs for help doing day-to-day tasks at home would improve members’ rating of their overall physical health by 2 to 3%, from 44%-45% to 47%.
Slide 50: Improving Rating of Mental and Emotional Health
•	Action addressing loneliness would improve members’ rating of their mental and emotional health by 4% from an average of 51% to 55%.
•	Helping members get together with people regularly would improve members’ rating of their mental and emotional health by 4% from an average of 50% to 54%.
•	Improving members’ relationships with health care and other providers would increase members’ rating of their mental and emotional health by 4% from an average of 46% to 50%.
•	Services and activities that would help members engage in meaningful work would improve members’ rating of their mental and emotional health by 3% from an average of 52% to 55%.
Slide 51: Improving Rating of Overall Life Satisfaction
•	Improving members’ environment so they feel safe where they live would improve members’ rating of their overall life satisfaction by ~6%, from an average of 72% to 79%. 
•	Ensuring members have all they need to live comfortably would improve members’ rating of their overall life satisfaction by 4%, from an average of 76% to 80%. 
•	Improving access to needed support from other people would improve members’ rating of their overall life satisfaction by 3%, from an average of 79% to 82%.
Slide 52: Policy Recommendations
Title slide only, no content on this slide.
Slide 53: Policy Recommendations (1)
To better address the needs of members who need just SOME help with 1) day-to-day tasks at home or 2) doing things in the community:

•	Evaluate whether service eligibility standards could be modified to provide needed assistance
•	Provide more in-depth assessment for those who need just SOME help. 

To better address the needs of all One Care members who need help with 1) day-to-day tasks at home or 2) doing things in the community

•	Evaluate whether the amounts of service authorized are sufficient
•	Expand the use of flexible benefits to address needs not covered under MassHealth/Medicare 
•	Expand access to transportation
Slide 54: Policy Recommendations (2)
Note: the following information is shown in a table on this slide.

Domain
	Physical Health

Statements
	Feel energetic throughout the day
	Ability to perform daily tasks 
	Ability to get around

Potential Strategies for Improvement
Continue efforts to connect members to services, assistive technology, and medical equipment that are needed to perform daily tasks through standard benefits/flexible funding. 

Assessment questions
•	Energy level
•	Reasons for lacking energy, e.g., medical condition, side effects of medication, depression, etc.
•	Enhance assessment questions about mobility

Train Care Coordinators and LTSCs about assistive technology/mobility aids.

Domain
	Mental or Emotional Health

Statements	
	I feel low on a regular basis, such as feeling blue, despair, anxiety, or depression
	Upbeat and positive attitude
	Confident about the decisions 
	Feeling lonely
	Getting together with people on a regular basis
	Improve concentration	

Potential Strategies for Improvement

Increase access to community transportation. 

Refer to services such as peer specialists, recovery coaches, or Wellness Recovery Action Plan (WRAP) training.

Include assessment questions about members’ decision-making processes and how confident they are about their decisions, loneliness, and the ability to concentrate.

Train Care Coordinators to refer members to providers/resources that can help to improve concentration..

Domain
	Life Satisfaction	

Statements	
	I am in control of my life
	Living life to the fullest
	Feel safe where members live
	Has everything I need to live comfortably
	Needed support from other people 	

Potential Strategies for Improvement

Assessment questions 
•	Unmet needs at home, relationships, and support services. 
•	Satisfaction with housing.
•	Feelings of safety at home to identify any reasons for feeling unsafe. 

Referrals to housing specialists or other services

Increase access to community transportation
Slide 55: Policy Recommendations (3) 
Note: the following statements are shown in a table on this slide. 

Domain
	Physical Health
	Mental and Emotional Health

Statements
	Capable of working
	Ease of getting medical services
	Have a good relationship with health care and other providers

Potential Strategies for Improvement

Continue efforts to expand provider networks.

Expand the use of single-use contracts with providers.

Increase access to community transportation.

Train Care Coordinators and LTSCs to 
•	Refer members to vocational rehabilitation services, e.g., Mass Ability and 
•	Benefit counselors for advice about benefits and work.

Domain
	Physical Health
	Mental or Emotional Health
	Life Satisfaction

Statements
	I enjoy life
	Feel good about self

Include assessment questions about:
•	How members feel about themselves and their lives 
•	Enjoyable activities 

Coordinate with social organizations that provide such activities.

Increase access to community transportation.
Slide 56: Research Team
Yara Halasa-Rappel, PhD, DMD
Research & Evaluation
yara.halasa@umassmed.edu 
781-330-9015

Linda Long-Bellil, PhD, JD
Research & Evaluation
linda.long@umassmed.edu
508-856-8417

Jianying Zhang, MPH, MD
Research & Evaluation
Jianying.Zhang@umassmed.edu

Ying (Elaine) Wang, PhD
Research & Evaluation
ying.wang@umassmed.edu
508-856-3268
Slide 57: Additional Slides
Title slide only, no content on this slide.

Slide 58: Respondents’ Demographics
•	Between 2019 and 2022, the One Care survey respondents had similar characteristics except for:
o	Marital status (% of respondents identified as singles increased, weighted)
•	Between 2019 and 2022, the FFS respondents had similar characteristics except for:
o	Age (% of respondents age 55+ increased, weighted)
o	Residency based on MassHealth regions ((% of respondents who reported living in Western Region increased and Southeast Region decreased, weighted)
•	One Care and FFS respondents were significantly different on:
o	Age (more 45-54-year-olds in One Care)
o	Race/ethnicity (more White in FFS)
o	Language spoken at home (more English speakers in FFS)
o	Level of education (More high school grad or above in FFS)
o	Region of residence (More FFS members resided in the Western region)

One Care

Demographics 	2019
# Respondents	569
# of weighted respondents	6,618

Demographics 	2020
# Respondents	482
# of weighted respondents	6,050

Demographics 	2021
# Respondents	474
# of weighted respondents	6,072

Demographics 	2022
# Respondents	485
# of weighted respondents	7,738

One Care %

2019
Age Category
18 to 34	3	NS
35 to 44	7
45 to 54	25
55+	63
Missing 	2
Gender
Male	43	NS
Female	55
Others	0
Missing 	2
Marital status
Single, never married	39	*
Married or partnered	17
Widowed 	7
Divorced/Separated 	34
Missing 	3
Race/Ethnicity
White (non-Hispanic)	57	NS
Hispanic or Latino	23
Black (non-Hispanic)	13
Multi-race or others race (non-Hispanic)	3
Missing 	5
Language spoken at home
English	78	NS
Spanish	15
Other language	1
Missing	6
Education level
Less than HS graduate	19	NS
HS grad or GED	36
Some college or more	40
Missing	5
Region
Western Region	27	NS
Central Region	17
Northeast Region	19
Metro West Region	14
Southeast Region	9
Boston Region	16

2020
Age Category
18 to 34	4	NS
35 to 44	8
45 to 54	22
55+	63
Missing 	3
Gender
Male	46	NS
Female	50
Others	1
Missing 	3
Marital status
Single, never married	43	*
Married or partnered	21
Widowed 	3
Divorced/Separated 	30
Missing 	3
Race/Ethnicity
White (non-Hispanic)	46	NS
Hispanic or Latino	27
Black (non-Hispanic)	17
Multi-race or others race (non-Hispanic)	5
Missing 	6
Language spoken at home
English	70	NS
Spanish	16
Other language	2
Missing	11
Education level
Less than HS graduate	21	NS
HS grad or GED	34
Some college or more	39
Missing	6
Region
Western Region	33	NS
Central Region	13
Northeast Region	21
Metro West Region	11
Southeast Region	9
Boston Region	13

2021
Age Category
18 to 34	4	NS
35 to 44	9
45 to 54	20
55+	63
Missing 	4
Gender
Male	42	NS
Female	54
Others	0
Missing 	3
Marital status
Single, never married	36	*
Married or partnered	22
Widowed 	8
Divorced/Separated 	28
Missing 	5
Race/Ethnicity
White (non-Hispanic)	51	NS
Hispanic or Latino	25
Black (non-Hispanic)	13
Multi-race or others race (non-Hispanic)	5
Missing 	6
Language spoken at home
English	74	NS
Spanish	16
Other language	1
Missing	9
Education level
Less than HS graduate	19	NS
HS grad or GED	32
Some college or more	42
Missing	7
Region
Western Region	30	NS
Central Region	15
Northeast Region	18
Metro West Region	13
Southeast Region	10
Boston Region	14

2022
Age Category
18 to 34	4	NS
35 to 44	9
45 to 54	21
55+	61
Missing 	4
Gender
Male	36	NS
Female	58
Others	1
Missing 	5
Marital status
Single, never married	43	*
Married or partnered	19
Widowed 	5
Divorced/Separated 	28
Missing 	5
Race/Ethnicity
White (non-Hispanic)	48	NS
Hispanic or Latino	29
Black (non-Hispanic)	11
Multi-race or others race (non-Hispanic)	7
Missing 	5
Language spoken at home
English	70	NS
Spanish	18
Other language	1
Missing	11
Education level
Less than HS graduate	18	NS
HS grad or GED	36
Some college or more	40
Missing	6
Region
Western Region	28	NS
Central Region	15
Northeast Region	19
Metro West Region	14
Southeast Region	13
Boston Region	12

FFS

Demographics 	2019
# Respondents	563
# of weighted respondents	15,544

Demographics 	2020
# Respondents	488
# of weighted respondents	15,936

Demographics 	2021
# Respondents	462
# of weighted respondents	15,495

Demographics 	2022
# Respondents	473
# of weighted respondents	16,141

FFS %

2019
Age Category
18 to 34	4	***
35 to 44	10
45 to 54	23
55+	58
Missing 	4
Gender
Male	42	NS
Female	53
Others	1
Missing 	4
Marital status
Single, never married	40	NS
Married or partnered	21
Widowed 	5
Divorced/Separated 	28
Missing 	6
Race/Ethnicity
White (non-Hispanic)	72	*
Hispanic or Latino	10
Black (non-Hispanic)	9
Multi-race or others race (non-Hispanic)	6
Missing 	4
Language spoken at home
English	88	NS
Spanish	5
Other language	1
Missing	6
Education level
Less than HS graduate	14	NS
HS grad or GED	38
Some college or more	43
Missing	5
Region
Western Region	25	***
Central Region	9
Northeast Region	14
Metro West Region	11
Southeast Region	32
Boston Region	8

2020
Age Category
18 to 34	3	***
35 to 44	5
45 to 54	16
55+	73
Missing 	3
Gender
Male	40	NS
Female	56
Others	0
Missing 	3
Marital status
Single, never married	33	NS
Married or partnered	26
Widowed 	7
Divorced/Separated 	29
Missing 	5
Race/Ethnicity
White (non-Hispanic)	71	*
Hispanic or Latino	13
Black (non-Hispanic)	7
Multi-race or others race (non-Hispanic)	3
Missing 	6
Language spoken at home
English	83	NS
Spanish	7
Other language	2
Missing	7
Education level
Less than HS graduate	17	NS
HS grad or GED	36
Some college or more	39
Missing	7
Region
Western Region	42	***
Central Region	9
Northeast Region	16
Metro West Region	8
Southeast Region	20
Boston Region	6

2021
Age Category
18 to 34	5	***
35 to 44	6
45 to 54	19
55+	67
Missing 	3
Gender
Male	39	NS
Female	58
Others	0
Missing 	3
Marital status
Single, never married	38	NS
Married or partnered	23
Widowed 	7
Divorced/Separated 	29
Missing 	3
Race/Ethnicity
White (non-Hispanic)	76	*
Hispanic or Latino	11
Black (non-Hispanic)	6
Multi-race or others race (non-Hispanic)	4
Missing 	3
Language spoken at home
English	87	NS
Spanish	6
Other language	2
Missing	5
Education level
Less than HS graduate	18	NS
HS grad or GED	36
Some college or more	41
Missing	6
Region
Western Region	41	***
Central Region	10
Northeast Region	13
Metro West Region	9
Southeast Region	22
Boston Region	5

2022
Age Category
18 to 34	2	***
35 to 44	4
45 to 54	15
55+	77
Missing 	2
Gender
Male	44	NS
Female	53
Others	1
Missing 	2
Marital status
Single, never married	34	NS
Married or partnered	23
Widowed 	8
Divorced/Separated 	31
Missing 	3
Race/Ethnicity
White (non-Hispanic)	78	*
Hispanic or Latino	11
Black (non-Hispanic)	4
Multi-race or others race (non-Hispanic)	3
Missing 	4
Language spoken at home
English	86	NS
Spanish	7
Other language	2
Missing	5
Education level
Less than HS graduate	17	NS
HS grad or GED	35
Some college or more	42
Missing	6
Region
Western Region	45	***
Central Region	11
Northeast Region	13
Metro West Region	8
Southeast Region	19
Boston Region	3

Notes: Results presented at the population level.  NS denotes not statistically significant; * P-value<0.05, *** P-value <0.001, $ The R/E of respondents to the FFS survey were missing for some categories which did not allow us to estimate the significant change over time   
Slide 59: Reported Disabilities or Health Conditions
•	Between 2019 and 2022, One Care respondents reported similar disabilities and health conditions except for:
o	% of respondents with long-term illness increased over time (weighted)
•	Between 2019 and 2022, the FFS respondents reported similar disabilities and health conditions, except for the following conditions: 
o	% of respondents with mental and psychiatric problems decreased over time (weighted)
o	% of respondents with long-term illness increased over time (weighted)
•	A higher percentage of One Care respondents reported multiple disabilities compared to FFS respondents
o	82% of One Care respondents reported having 2 or more disabilities compared to 68% of FFS respondents
•	One Care and FFS respondents were significantly different when it comes to:
o	Mental or psychiatric problems (higher among One Care respondents)
o	Long-term illness (higher among One Care respondents)
o	Learning disability (higher among One Care respondents)
o	Visual impairment or blindness (higher among One Care respondents)
One Care %

2019
Physical disabilities 	61
Mental or psychiatric problems	69
Problems with alcohol or drug abuse	6
Long-term illness 	52
Developmental disability	8
Learning disability	24
Visual impairment or blindness	22
Hearing loss or deafness	17
Reported 2 or more disabilities	75

2020
Physical disabilities 	61
Mental or psychiatric problems	62
Problems with alcohol or drug abuse	8
Long-term illness 	52
Developmental disability	12
Learning disability	28
Visual impairment or blindness	27
Hearing loss or deafness	18
Reported 2 or more disabilities	75

2021
Physical disabilities 	58
Mental or psychiatric problems	60
Problems with alcohol or drug abuse	7
Long-term illness 	55
Developmental disability	9
Learning disability	27
Visual impairment or blindness	26
Hearing loss or deafness	17
Reported 2 or more disabilities	76

2022
Physical disabilities 	67
Mental or psychiatric problems	63
Problems with alcohol or drug abuse	5
Long-term illness 	63	*
Developmental disability	10
Learning disability	24
Visual impairment or blindness	27
Hearing loss or deafness	15
Reported 2 or more disabilities	82

FFS  %

2019
Physical disabilities 	63
Mental or psychiatric problems	64
Problems with alcohol or drug abuse	5
Long-term illness 	48
Developmental disability	11
Learning disability	22
Visual impairment or blindness	20
Hearing loss or deafness	16
Reported 2 or more disabilities	74

2020
Physical disabilities 	62
Mental or psychiatric problems	61
Problems with alcohol or drug abuse	7
Long-term illness 	59
Developmental disability	7
Learning disability	21
Visual impairment or blindness	20
Hearing loss or deafness	16
Reported 2 or more disabilities	76

2021
Physical disabilities 	58
Mental or psychiatric problems	60
Problems with alcohol or drug abuse	4
Long-term illness 	52
Developmental disability	10
Learning disability	24
Visual impairment or blindness	21
Hearing loss or deafness	16
Reported 2 or more disabilities	71

2022
Physical disabilities 	58
Mental or psychiatric problems	55	*
Problems with alcohol or drug abuse	6
Long-term illness 	51	*
Developmental disability	7
Learning disability	18
Visual impairment or blindness	20
Hearing loss or deafness	15
Reported 2 or more disabilities	68

Notes: NS denotes not statistically significant; * P-value<0.05
Slide 60: Methods: Sampling
Note: the following statements are shown in a table on this slide. 
Sample Frame
•	Received MH enrollment files 
•	Selected three random samples of One Care plans (Tufts and CCA) and FFS members who were enrolled as of December of the survey measurement year
•	There were no limits on length of enrollment
•	Each sample was given a weight value representing the enrollee in each health plan  

Exclusion criteria (sampling)
•	Participation in the QoL Survey during the year prior to the current survey
•	Invalid contact information (e.g., phone number)
•	Reside outside MA
•	Reported primary language not English or Spanish (due to restrictions in survey administration)*

Ineligibility criteria
(survey implementation)
Unable to complete the survey due to 
•	Physical and mental incapacity
•	Communication barriers 
•	Deceased

* Most of members have English as primary language by default regardless of the actual primary language spoken at home