VOL. 15, NO. 1 n THE AMERICAN JOURNAL OF MANAGED CARE n฀ 13 n CLINICAL n © Managed Care & Healthcare Communications, LLC H urricane Katrina has had profound and ongoing effects on the health of inhabitants of the city of New Orleans, Louisi- ana, and surrounding areas. Numerous reports on the imme- diate health effects of Hurricane Katrina have focused on surveillance of the following: mortality, injury, and illness 1,2 ; mental health prob- lems 3 ; health services utilization 4,5 ; disruption to the healthcare de- livery system 4,6,7 ; implications for patient care during disasters 8 ; and suggestions for health policy change. 9 Although the disaster literature contains many studies on the immediate health effects of natural di- sasters, few (including the Hurricane Katrina literature) have tracked health outcomes during the long term or have been able to compare health status before an event versus after an event. 10,11 Older adults with a heavy burden of chronic conditions require effective care deliv- ery systems 12 ; however, few studies to date have focused on the health effects following a major disruption to care delivery such as occurred with Hurricane Katrina. The first objective of this study was to document mortality associ- ated with Hurricane Katrina in a defined population of older adults. The second objective was to explore the relationship between prehurricane health risk status and the effects of the hurricane on morbidity and health service use in a population of continuously enrolled older persons from a New Orleans–based Medicare Advantage plan. METHODS Peoples Health (PH) is a provider-owned managed care organization (MCO) that served approximately 20% of all Medicare beneficiaries 65 years and older in 4 parishes around New Orleans before Hurricane Katrina through its Medicare Advantage plan, with a provider network of 7 independent practice associations representing 1101 participating physicians (160 primary care physicians and 941 specialists). Peoples Health remained operational throughout Hurricane Katrina, moving its administrative operations from New Orleans to Baton Rouge, Louisi- ana. Through December 2006, PH used mailings, their Web site, and the news media to inform its members that all copayments and deduct- ibles for out-of-area services would be waived as required by the Centers for Medicare & Medicaid Services. 13 The information system of PH captures all data on outpatient and office encoun- In this issue Take-away Points / p20 www.ajmc.com Full text and PDF Health of Medicare Advantage Plan Enrollees at 1 Year After Hurricane Katrina Lynda C. Burton, ScD; Elizabeth A. Skinner, MSW; Lori Uscher-Pines, PhD; Richard Lieberman, BA; Bruce Leff, MD; Rebecca Clark, BA; Qilu Yu, PhD; Klaus W. Lemke, PhD; and Jonathan P. Weiner, DrPH Objective: To assess the effects of Hurricane Ka- trina on mortality, morbidity, disease prevalence, and service utilization during 1 year in a cohort of 20,612 older adults who were living in New Orleans, Louisiana, before the disaster and who were enrolled in a managed care organization (MCO). Study Design: Observational study comparing mortality, morbidity, and service use for 1 year before and after Hurricane Katrina, augmented by a stratified random sample of 303 enrollees who participated in a telephone survey after Hurricane Katrina. Methods: Sources of data for health and service use were MCO claims. Mortality was based on reports to the MCO from the Centers for Medicare & Medicaid Services; morbidity was measured using adjusted clinical groups case-mix methods derived from diagnoses in ambulatory and hospi- tal claims data. Results: Mortality in the year following Hurricane Katrina was not significantly elevated (4.3% be- fore vs 4.9% after the hurricane). However, overall morbidity increased by 12.6% (P <.001) compared with a 3.4% increase among a national sample of Medicare managed care enrollees. Nonwhite sub- jects from Orleans Parish experienced a morbidity increase of 15.9% (P <.001). The prevalence of nu- merous treated medical conditions increased, and emergency department visits and hospitalizations remained significantly elevated during the year. Conclusions: The enormous health burden expe- rienced by older individuals and the disruptions in service utilization reveal the long-term effects of Hurricane Katrina on this vulnerable popula- tion. Although quick rebuilding of the provider network may have attenuated more severe health outcomes for this managed care population, new policies must be introduced to deal with the health consequences of a major disaster. (Am J Manag Care. 2009;15(1):13-22) For author information and disclosures, see end of text.