Effects of Expanding Medicare Advantage Enrollment toPersons with End-stage Renal Disease

扩大医疗保险优惠覆盖范围对终末期肾病患者的影响

基本信息

批准号：
10275943
负责人：
AMAL N. TRIVEDI
金额：
$ 66.95万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-21 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10275943
关键词：
Address Admission activity Adopted American Caring Cessation of life Characteristics Clinical Communities Complex County Data Diagnosis Dialysis patients Dialysis procedure Disadvantaged End stage renal failure Enrollment Evaluation Face Geography Health Health Policy Health Services Accessibility Healthcare Hemodialysis Home Hospitalization Impairment Incentives Incidence Interview Kidney Kidney Diseases Kidney Failure Kidney Transplantation Low income Managed Care Managed Care Programs Medicare Methods Modeling Morbidity - disease rate Neighborhoods Nephrology Outcome Patient-Focused Outcomes Patients Peritoneal Dialysis Persons Policies Population Population Intervention Poverty Privatization Provider Quality of Care Quality of life Renal Replacement Therapy Risk Risk Factors Role Services Testing Time Transplantation United States Centers for Medicare and Medicaid Services Ursidae Family Variant Waiting Lists base beneficiary black patient bundled payment care outcomes community center cost design ethnic minority population experimental study falls health equity hospital readmission improved improved outcome innovation insight living kidney donor mortality novel payment programs racial and ethnic racial disparity social social health determinants socioeconomics

项目摘要

Project Summary The over 500,000 Americans with dialysis-dependent kidney failure, also known as end-stage renal disease (ESRD), suffer from high mortality rates, severe morbidity, impaired quality of life, and frequent hospitalizations and readmissions. The burden of ESRD falls heavily on disadvantaged communities, with higher incidence rates and lower access to nephrology care among racial/ethnic minority populations and those living in high-poverty neighborhoods. Changes in coverage and payment financing policies in the Medicare program have had substantial consequences for access to care and health equity in the ESRD population. For instance, Medicare's decision in 1973 to extend coverage to Americans with irreversible kidney failure led to marked reductions in deaths due to kidney disease and decreased racial disparities in access to dialysis. Effective January 1, 2021, Medicare will open up enrollment of ESRD patients in private Medicare Advantage (MA) plans. Historically, persons with ESRD have been ineligible to join MA plans except under limited exceptions. Eighty-three thousand persons with ESRD (14% of Medicare's ESRD population) are projected to join an MA plan within two years. Unfortunately there is little evidence to guide policymakers about the consequences of managed care for persons with ESRD, variations across plans, and the implications for disparities in kidney health. More broadly, MA enrollment has more than quadrupled over the past 15 years, yet fundamental questions about the value of managed care for persons for serious health conditions remain answered. Our long-term objective is to understand the effects of payment and financing changes on the quality, equity, and outcomes of care for persons with ESRD. This mixed-methods study, the next step in our agenda, will investigate the impact of the Medicare program's expansion of MA enrollment to the ESRD population on dialysis care, hospitalizations and mortality. Our specific aims are: 1. Examine MA plans' approaches to managing care for persons with ESRD by conducting qualitative interviews with representatives from MA plans, dialysis organizations, and dialysis facility staff in geographically diverse markets. 2. Estimate the impact of expanding MA coverage to patients with ESRD on mode of kidney replacement therapy, hospitalizations and mortality. 3. Identify variations in the impact of Medicare Advantage on ESRD outcomes by patient and plan characteristics. The project is innovative because we leverage an unprecedented policy experiment in the Medicare program and the availability of plans across counties to derive causal estimates of the impact of managed care for dialysis patients. This project will have a positive impact by producing timely evidence about the role of MA plans in delivering care for persons with ESRD, a population with complex health needs and social risk factors. We address survival, hospitalizations, and the use of home dialysis, outcomes that have been prioritized by the nephrology community, the Medicare program, and the 2019 Executive Order on Advancing American Kidney Health.

项目摘要超过500,000名患有透析依赖肾衰竭的美国人，也称为终点肾脏疾病（ESRD），死亡率高，发病率严重，生活质量受损和频繁住院和再入院。 ESRD的负担严重落在了处境不利的社区上，在种族/族裔少数族裔人口中，发病率较高，较低那些居住在高贫困社区的人。覆盖范围和付款融资政策的变化 Medicare计划对ESRD的获得护理和健康公平产生了重大影响人口。例如，Medicare在1973年的决定将覆盖范围扩展到不可逆的肾脏失败导致因肾脏疾病而导致的死亡人数明显减少，而种族差异减少了透析。自2021年1月1日起，Medicare将开放ESRD患者的私人Medicare 优势（MA）计划。从历史上看，ESRD的人没有资格加入MA计划。有限的例外。 ESRD的八万人（占Medicare ESRD人口的14％）是预计将在两年内加入MA计划。不幸的是，几乎没有证据可以指导政策制定者对具有ESRD的人的管理护理的后果，计划跨计划的变化以及对肾脏健康的差异。更广泛地说，在过去的15年中，MA入学率超过三倍，然而，关于严重健康状况的管理人员的托管护理价值的基本问题仍然存在回答。我们的长期目标是了解付款和融资变化对 ESRD患者的质量，公平和护理结果。这项混合方法研究，我们的下一步议程将调查Medicare计划将MA入学率扩展到ESRD的影响透析护理，住院和死亡率的人口。我们的具体目的是：1。检查MA计划' 通过与代表进行定性访谈，管理ESRD的人的护理方法来自MA计划，透析组织和地理不同市场的透析设施员工。 2。估计扩大MA覆盖范围对ESRD患者对肾脏替代疗法模式的影响，住院和死亡率。 3。确定Medicare Advantage对ESRD结果的影响的变化由患者和计划特征。该项目具有创新性，因为我们利用了前所未有的政策 Medicare计划的实验以及跨县的计划的可用性，以得出因果估计透析患者托管护理的影响。该项目将通过及时产生积极影响关于MA计划在为ESRD的人提供护理方面的作用的证据，ESRD是一个复杂的人群健康需求和社会风险因素。我们解决生存，住院和家庭透析的使用，肾脏病社区，Medicare计划和2019年优先考虑的结果提高美国肾脏健康的行政命令。