Improving Medicare in an Era of Change: Deaths in Long-Term Care Facilities During the COVID-19 Era

在变革时代改善医疗保险：COVID-19 时代长期护理机构的死亡人数

• 批准号: 10288393
• 负责人: Bruce E. Landon
• 金额: $ 45.01万
• 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/10288393
• 关键词: Accountability; Adoption; Affect; Area; Automobile Driving; Award; COVID-19; Caring; Cessation of life; Contracts; Data; Data Sources; Dementia; Disabled Persons; Elderly; Elements; Empirical Research; Enrollment; Evolution; Failure; Foundations; Goals; Health; Health Services Accessibility; Health care facility; Healthcare; Healthcare Systems; Incentives; Individual; Lead; Leadership; Learning; Link; Long-Term Care; Measures; Medicaid; Medicare; Medicare/Medicaid; Methodology; Methods; Modeling; Monitor; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Patterns of Care; Performance; Personal Satisfaction; Physicians; Policies; 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; 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.

项目概要/摘要 成功整合医疗融资和提供服务仍然是医疗保险计划的首要目标 经过多年的不断努力，包括最近一段前所未有的实验。 医疗保险的变化为了解支付系统如何影响患者护理和 Medicare Advantage (MA) 计划是 Medicare 整合融资的最重要尝试。 目前，36% 的受益人参加了可影响患者护理的按人头私人计划。 以及通过多种机制取得的成果，包括选择性签约、福利设计和关怀 鉴于大多数受益人仍在传统医疗保险 (TM) 中，医疗保险已经 实施的目的是将融资和护理纳入该计划的努力中，包括替代支付方式 医疗保险与提供者直接签订风险合同的模型（APM） 关于 MA 优点的证据是。 很大程度上是观察性的，而且对 APM 的相对性能知之甚少。 直到最近，有关 MA 的数据仍不清楚，也没有得到充分研究。 计划不足以支持对护理模式和护理模式差异的详细实证探索 驱动它们的潜在机制比比皆是的州医疗补助计划有很多潜在的教训。 使用比 MA 计划更窄的提供者网络，并且越来越多地将护理管理委托给私人机构 计划，但医疗补助和医疗保险中采取的方法对患者护理的相对影响尚未得到证实 各种整合举措都认识到，一种规模并不适合所有支付方式； 具有前瞻性或包含前瞻性元素，为计划和提供商提供了更大的灵活性 选择护理投入来支持患者的健康和福祉，但这对特殊患者的影响。 支付系统设计和性能监控方面仍存在许多挑战， 因此，随着医疗保险的创新和发展，需要进行合理的分析。 生成证据基础以了解支付系统如何影响患者。 “在变革时代改善医疗保险”重点关注医疗保险计划变化的后果 它旨在为设计健康支付系统提供基础见解。 我们的研究议程包括四个关键领域：1）MA 和 TM 的比较表现以及 每个的变体；2) MA 计划采用的策略；3) 向州医疗补助计划学习；4) 患有痴呆症的医疗保险患者的经历及其对支付系统完善的影响 我们的提案基于我们当前的计划项目，利用新数据。 来源和实证方法：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潜在的改进方向 日益多样化的医疗保险和医疗补助计划中的系统特征。