Grant: #73052

Grantee Institution: The Regents of the University of California, Los Angeles

Principal Investigator: Kathryn Kietzman, Ph.D.

Grant Period: October 1, 2015 – September 30, 2017

Budget: $399,130

Project Aim: To examine the factors that lead dual eligible health care consumers to enroll and remain in either a Fee-For-Service (FFS) or a Managed Care (MC) setting and to better understand the factors that contribute to the managed care plan Cal MediConnect’s low enrollment rates.

Key Findings:

  • While extra benefits offered through Cal MediConnect were attractive, many consumers were willing to forgo these advantages in order to remain with an existing and trusted network of care.
  • Consumer “knowledge” of health plan options varied depending on who delivered the information; some sources of information were greater influencers than others.
    • While older adults, people with complex care needs, and Spanish-speaking participants tended to trust information provided by people with whom they had long-standing relationships, younger adults and English-speaking consumers were more likely to seek out multiple sources of information, including sources provided by the state of California or the Cal MediConnect health plan.
  • The consumer’s trust in the information source sometimes resulted in the receipt of inaccurate information.

Project Description: 

More than nine million health care consumers are dually eligible for Medicare and Medicaid, including both seniors with multiple chronic conditions and young people with significant disabilities. Dual eligibles areamong the poorest and sickest of consumers and account for a disproportionate share of utilization and spending in both Medicare and Medicaid. The researchers conducted a series of one-on-one interviews and focus group discussions with dual eligibles in California, a state that began enrolling duals in a new managed care program in 2014.  In this context, the researchers examined how dual eligibles 1) make decisions about health care coverage; 2) access and incorporate different information sources into their decision-making; and 3) perceive the value of receiving health care through fee-for-service or managed care.  The goal of this project was to help inform strategies for effectively communicating with and responding to the preferences of dual eligible health care consumers, while also identifying practices that, in general, better support health-related consumer decision-making.

This project was funded as part of the Robert Wood Johnson Foundation’s solicitation “Optimizing Value in Health Care: Consumer-focused Trends from the Field,” which supported studies that addressed consumer perceptions of value in the new and emerging health care landscape.


Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California
Journal of Immigrant and Minority Health | July 2019

Study Snapshot: Understanding the Preferences of Dual-Eligible Consumers in Los Angeles County
AcademyHealth | September 2018

Cal MediConnect Enrollment: Why are Dual-Eligible Consumers in Los Angeles County Opting Out?
UCLA Fielding School of Public Health | September 2017