Does Managed Care Improve End-of-Life Care for Medicare Beneficiaries?

管理式医疗是否能改善医疗保险受益人的临终护理？

• 批准号: 10515439
• 负责人: Lauren Hersch Nicholas
• 金额: $ 43.68万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10515439
• 关键词: Does; Managed; Care; Improve; End

PROJECT SUMMARY Numerous studies and a recent Institute of Medicine report have raised concerns about the quality of end-of- life (EOL) care provided to older adults in the United States. Many Medicare beneficiaries receive burdensome treatments (e.g. feeding tube placement, dialysis, and intensive care unit stays) that do not extend their life, die in a hospital, and experience transitions from one setting of care to another late in life. These treatments come at significant financial and emotional cost to the Medicare program, individual beneficiaries and their families, and are associated with the financial incentives and fragmented delivery system embedded in Fee-for-Service (FFS) Medicare. Despite repeated calls to improve patient experiences at the end-of-life (EOL), especially for older adults with Alzheimer's Disease and Related Dementias (ADRD) and other life-limiting illness, little research has considered whether managed care could achieve these goals. Medicare Advantage (MA), the voluntary, managed care alternative to FFS now covers 33% of Medicare beneficiaries at time of death. MA plans receive capitated payments for each beneficiary and are shielded from the cost of most care provided to beneficiaries who enroll in hospice care. These incentives may encourage provision of high-quality EOL care for terminally ill patients. While a small number of descriptive studies point to more appropriate EOL care provision with managed care, the literature has not yet accounted for non-random enrollment in MA, studied MA across market conditions, assessed EOL care for patients with life-limiting illness in MA or examined outpatient EOL care in MA. To address this gap, our team of health economists, health services researchers, physicians and nurse practitioners will use econometric methods with Medicare claims data from 2015 – 2018 including newly available Medicare Advantage encounter data to assess whether and how managed care enrollment affects care for patients with life-limiting illnesses (ADRD, metastatic cancer and end-stage organ failure). We will 1- test whether MA reduces use of potentially inappropriate care near the end-of-life for these patients; 2- assess whether MA provides better outpatient care near the end-of-life to reduce potentially burdensome transitions; and 3- test whether the effect of MA varies with local practice styles, plan payments, and MA market share. The end-of-life represents the most intensive period of healthcare utilization for many Americans. With one- third of Medicare beneficiaries now receiving coverage through MA, it is critical to understand potential differences in the quality of care provided at this time. Information about differences between managed care and traditional Medicare is essential to understand how financial incentives influence EOL care and to develop incentives that better align with patient preferences.

项目概要 大量研究和最近的医学研究所报告引起了人们对最终治疗质量的担忧。 在美国，许多医疗保险受益人都承受着沉重的生活负担。 无法延长生命的治疗（例如放置饲管、透析和入住重症监护室）会导致死亡 在医院，并在晚年经历从一种护理环境到另一种护理环境的转变。 给医疗保险计划、个人受益人及其家人带来巨大的经济和情感成本， 并与按服务收费中嵌入的经济激励和分散的交付系统相关 (FFS) 医疗保险。尽管人们多次呼吁改善临终患者 (EOL) 的体验，特别是对于患者而言。 患有阿尔茨海默病和相关痴呆症 (ADRD) 以及其他限制生命的疾病的老年人很少 研究考虑了管理式医疗是否可以实现这些目标。 Medicare Advantage (MA) 是 FFS 的自愿管理式医疗替代方案，目前涵盖 33% 的 Medicare MA 计划的受益人在死亡时收到每个受益人的付款并受到保护。 这些激励措施可能包括向参加临终关怀的受益人提供的大多数护理的费用。 鼓励为绝症患者提供高质量的 EOL 护理，同时为少数描述性患者提供服务。 研究指出，通过管理式护理提供更合适的 EOL 护理，但文献尚未说明 针对 MA 的非随机入组，研究了不同市场条件下的 MA，评估了对患有以下疾病的患者的 EOL 护理 马萨诸塞州的生命限制性疾病或马萨诸塞州的门诊 EOL 护理检查。 为了解决这一差距，我们的健康经济学家、卫生服务研究人员、医生和护士团队 从业者将使用计量经济学方法处理 2015 年至 2018 年的医疗保险索赔数据，包括新的 可用的 Medicare Advantage 遇到数据来评估管理式医疗注册是否以及如何影响 护理患有限制生命的疾病（ADRD、转移性癌症和终末期器官衰竭）的患者，我们将 1-。 测试 MA 是否会减少这些患者临终时可能使用的不当护理 2- 评估； MA 是否在临终时提供更好的门诊护理，以减少潜在的繁重过渡； 3-测试 MA 的效果是否随当地实践风格、计划付款和 MA 市场份额而变化。 对于许多美国人来说，临终时期是医疗保健利用最密集的时期。 三分之一的医疗保险受益人现在通过 MA 获得保险，了解潜在的潜力至关重要 目前提供的护理质量的差异 有关管理式护理之间差异的信息。 传统的医疗保险对于了解经济激励如何影响 EOL 护理并发展 更好地符合患者偏好的激励措施。