The Effects of Medicare Advantage on Healthcare Use and Patient Outcomes

医疗保险优势对医疗保健使用和患者结果的影响

基本信息

批准号：
10366609
负责人：
Peter Huckfeldt
金额：
$ 42.6万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10366609
关键词：
Address Budgets Caring Characteristics Communities Complex Cost Sharing Data Drug Prescriptions Drug usage Elderly Emergency department visit Enrollment Fee-for-Service Plans Freedom Geographic Locations Grant Health Health Benefit Health Status Healthcare Hip Fractures Home Care Services Hospitalization Hospitals Incentives Insurance Carriers Lead Measures Medicare Myocardial Infarction Natural experiment Occupations Outcome Outpatients Patient-Focused Outcomes Patients Performance Pilot Projects Policies Privatization Provider Quality of Care Research Service provision Services Severities Signal Transduction Stroke Structure Telemedicine United States Centers for Medicare and Medicaid Services Variant Visit Work acute care base beneficiary care providers cost design financial incentive flexibility functional status health care quality improved innovation mortality patient subsets payment prior authorization programs provider networks residence retiree tool

项目摘要

Project Summary/ Abstract A growing share of Medicare beneficiaries are enrolled in Medicare Advantage (MA) rather than traditional fee- for-service (TM) Medicare, with the MA share increasing from 13% in 2004 to 39% in 2020. The Centers for Medicare and Medicaid Services (CMS) pay MA plans a monthly capitated rate to cover nearly all health care expenses for plan enrollees. MA plans keep as profits the portion of payments that are not used to cover enrollee expenses. In addition, CMS grants MA plans greater freedom to manage enrollees’ health care use, for example, through tools such as narrow provider networks and broader coverage of delivery innovations such as telemedicine. Proponents argue that these financial incentives and effective tools for MA plans might enable them to provide care more efficiently than TM. On the other hand, these effects could be offset by financial incentives under capitation to limit service provision beyond what is necessary to improve short term health, resulting in adverse impacts on longer-term outcomes. Prior work has primarily estimated cross-sectional comparisons of TM and MA enrollees, which could lead to biased estimates if MA enrollees differ from TM enrollees in other ways that are related to health care use and health outcomes. Our proposed project will study changes in MA enrollment coming from seven states that recently changed public retiree health benefits from supplemental TM coverage to mandatory MA plans (or in one state, from a mandatory MA plan to supplemental TM coverage). We will use these natural experiments, along with comprehensive Medicare data for TM and MA enrollees, to estimate the causal impact of MA enrollment on health care use, quality, and patient outcomes. These results will provide important evidence to policymakers weighing broader expansions of Medicare Advantage.

项目概要/摘要越来越多的 Medicare 受益人加入 Medicare Advantage (MA)，而不是传统的收费计划。服务 (TM) 医疗保险，MA 份额从 2004 年的 13% 增加到 2020 年的 39%。医疗保险和医疗补助服务 (CMS) 支付 MA 计划每月按人头付费，以涵盖几乎所有医疗保健 MA 计划将未用于承保参与者的付款部分保留为利润。此外，CMS 赋予 MA 计划更大的自由来管理参保者的医疗保健使用，例如，通过狭窄的提供商网络和更广泛的交付创新覆盖范围等工具支持者认为，这些财务激励措施和 MA 计划的有效工具可能使远程医疗成为可能。另一方面，这些影响可以通过财务来抵消。按人头付费的激励措施，将提供的服务限制在改善短期健康所需的范围之外，先前的工作主要估计了横截面结果。 TM 和 MA 注册者的比较，如果 MA 注册者与 TM 不同，可能会导致估计偏差我们提议的项目将研究与医疗保健使用和健康结果相关的其他方式的参与者。七个州的 MA 入学率发生了变化，这些州最近改变了公共退休人员的健康福利强制性 MA 计划的补充 TM 保险（或在一个州，从强制性 MA 计划到补充我们将使用这些自然实验以及 TM 和 MA 的综合医疗保险数据。参与者，以估计 MA 注册对医疗保健使用、质量和患者结果的因果影响。这些结果将为决策者权衡扩大医疗保险范围提供重要证据优势。