Improving Medicare in an Era of Change: Natural experiments to understand protective effects of Medicaid and Medicare policy during the COVID-19 pandemic for populations with a high rates of dementia

在变革时代改善医疗保险：通过自然实验了解 COVID-19 大流行期间医疗补助和医疗保险政策对痴呆症高发人群的保护作用

• 批准号: 10287696
• 负责人: John Michael McWilliams
• 金额: $ 42万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10287696
• 关键词: Accountability; Adoption; Affect; Area; Automobile Driving; Award; COVID-19 pandemic; Caring; Contracts; Data; Data Sources; Dementia; Disabled Persons; Elderly; Elements; Empirical Research; Enrollment; Evolution; Failure; Foundations; Goals; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Incentives; Individual; Lead; Leadership; Learning; Link; Measures; Medicaid; Medicare; Medicare/Medicaid; Methodology; Methods; Modeling; Monitor; Natural experiment; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Patterns of Care; Performance; Personal Satisfaction; Physicians; Policies; Population; Positioning Attribute; Privatization; Program Research Project Grants; Provider; Quality of Care; Quasi-experiment; Replacement Arthroplasty; Research; Research Design; Research Infrastructure; Research Methodology; Research Personnel; Research Project Grants; Risk; Risk Adjustment; Savings; Security; System; Talents; Techniques; Translating; Update; Variant; Work; base; beneficiary; bundled payment; cancer care; care delivery; care outcomes; comparative; design; evidence base; experience; flexibility; health plan; improved; innovation; insight; intrinsic motivation; payment; programs; prospective; protective effect; provider networks; sound; wasting

PROJECT SUMMARY/ABSTRACT Successfully integrating the financing and delivery of care remains a primary goal of the Medicare program after years of expanding efforts, including a recent period of unprecedented experimentation. The resulting changes in Medicare have created opportunities to understand how payment systems affect patient care and outcomes. The Medicare Advantage (MA) program is Medicare's most significant attempt to integrate financing and care. Currently 36% of beneficiaries are enrolled in capitated private plans that can influence patient care and outcomes through multiple mechanisms, including selective contracting, benefit design, and care management. Given that the majority of beneficiaries remain in Traditional Medicare (TM), Medicare has implemented efforts to integrate financing and care in that program as well, including alternative payment models (APMs) in which Medicare risk-contracts with providers directly. The evidence on the merits of MA is largely observational, and little is known about the relative performance of APMs. Moreover, the implications of integrated financing and delivery for patients remain unclear and understudied. Until recently, data on the MA program were insufficient to support detailed empirical exploration of differences in care patterns and the potential mechanisms driving them. Potential lessons abound from state Medicaid programs, which typically use narrower provider networks than MA plans and have increasingly delegated care management to private plans, but the relative impact on patient care of approaches taken in Medicaid and Medicare have not been quantified. There is recognition across the various integration initiatives that one size does not fit all; payments that are prospective, or incorporate prospective elements, give plans and providers greater flexibility in selecting inputs of care to support patients' health and well-being. But the implications for patients with special needs are poorly understood. Many challenges remain in payment system design and performance monitoring, particularly in methods of risk adjustment. Thus, as Medicare innovates and evolves, sound analysis is needed to generate an evidence base for understanding how payment systems affect patients. This Program Project, “Improving Medicare in an Era of Change,” focuses on the consequences of a changing Medicare program for patient care and outcomes. It intends to supply foundational insights for designing payment systems in health care. Our research agenda encompasses four key areas: 1) comparative performance of MA and TM and variants of each; 2) strategies employed by MA plans; 3) learning from state Medicaid programs; and 4) experiences of Medicare patients with dementia and their implications for payment system refinements for patients with special needs. Our proposal builds on our current Program Project by leveraging new data sources and empirical approaches to: examine previously unanswerable questions; support rigorous system comparisons; and identify potential directions for improvement by exploring variation in payment and delivery system features in the increasingly heterogeneous Medicare and Medicaid programs.

项目摘要/摘要 成功整合护理的融资和交付仍然是Medicare计划的主要目标 经过多年的扩大努力，包括最近的前所未有的实验。结果 医疗保险的变化创造了了解支付系统如何影响患者护理和 结果。 Medicare Advantage（MA）计划是Medicare整合融资的最重要尝试 和关心。目前，有36％的受益人已入学，这可能会影响患者护理 以及通过多种机制的结果，包括选择性合同，福利设计和护理 管理。鉴于大多数受益人仍然存在于传统医疗保险（TM）中，Medicare拥有 也实施了将融资和护理整合到该计划中的努力，包括替代付款 Medicare风险合同直接​​与提供商合同的模型（APM）。关于马的优点的证据是 关于APM的相对性能，在很大程度上观察到了。而且， 患者的综合融资和分娩尚不清楚和理解。直到最近，有关MA的数据 计划不足以支持对护理模式差异的详细经验探索和 驱动它们的潜在机制。州医疗补助计划的潜在课程比比皆是，通常 使用比MA计划更狭窄的提供商网络，并已越来越多地将护理管理委派给私人 计划，但对医疗补助和医疗保险采取方法的患者护理的相对影响尚未 量化。在各种整合计划中都有认可，即一种尺寸并不适合所有尺寸。付款 潜在的，或结合潜在的要素，为计划和提供者提供了更大的灵活性 选择护理的投入以支持患者的健康和福祉。但是对特殊患者的影响 需求知之甚少。付款系统设计和性能监控中仍然存在许多挑战， 特别是在风险调整方法中。作为医疗保险的创新和发展，需要声音分析 为了了解支付系统如何影响患者的证据基础。这个程序项目， “在变革时代改善医疗保险”，重点介绍了不断变化的Medicare计划的后果 病人的护理和结果。它打算提供用于设计健康支付系统的基本见解 关心。我们的研究议程包括四个关键领域：1）MA和TM的比较性能以及 每个变体； 2）MA计划采用的策略； 3）从国家医疗补助计划中学习；和4） Medicare患者患有痴呆症患者的经验及其对支付系统改进的影响 有特殊需要的患者。我们的建议通过利用新数据来建立我们当前的计划项目 来源和经验方法：检查以前无法回答的问题；支持严格的系统 比较；并通过探索付款和交付的变化来确定改进的潜在方向 系统特征在越来越多的医疗保险和医疗补助计划中。