Individuals enrolled in both the Medicare and Medicaid programs, the "dually eligible," are generally vulnerable and face a wide range of health care needs; numerous studies have found that their health care is beset with problems of cost and quality. Health policy researchers find that these problems are directly associated with the inadequate coordination of benefits and services, but studies about care coordination have largely used quantitative approaches and focused on providers—they have not explored the critical perspective of patients receiving the care. To improve the complex processes of care coordination, this hybrid case study examines the experience of a sample of dual eligible enrollees served in North Carolina's patient centered medical home, and care managers. The subjects were generally independently living, and at lower-risk that typical dual eligibles. Although some experienced some continuity of care issues within NC's PCMH, generally they described receiving the right care, at the right time, in the right care settings. However, some experienced barriers to accessing necessary care, especially in the areas of prescription drugs and navigating the health care delivery system. Some of these challenges could potentially be resolved by NC's PCMH, but many issues are outside the program's control. Care managers who were interviewed suggested modifications to the Agency for Healthcare Research and Quality's Care Coordination Ring, which represents care coordination for a more stable, middle-class population than the dual eligibles they serve.
|Advisor:||Infeld, Donna L.|
|Commitee:||Goetz Goldberg, Debora, Lind, Alice, Lipson, Debra J., Mead, Katherine Holly, Rosenbaum, Sara|
|School:||The George Washington University|
|Department:||Public Policy and Public Administration|
|School Location:||United States -- District of Columbia|
|Source:||DAI-B 75/08(E), Dissertation Abstracts International|
|Subjects:||Aging, Health care management|
|Keywords:||Care coordination, Care manager, Dual eligibles, Fee for service, Patient centered medical home, Primary care|
Copyright in each Dissertation and Thesis is retained by the author. All Rights Reserved
The supplemental file or files you are about to download were provided to ProQuest by the author as part of a
dissertation or thesis. The supplemental files are provided "AS IS" without warranty. ProQuest is not responsible for the
content, format or impact on the supplemental file(s) on our system. in some cases, the file type may be unknown or
may be a .exe file. We recommend caution as you open such files.
Copyright of the original materials contained in the supplemental file is retained by the author and your access to the
supplemental files is subject to the ProQuest Terms and Conditions of use.
Depending on the size of the file(s) you are downloading, the system may take some time to download them. Please be