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：
10435533
负责人：
AMAL N. TRIVEDI
金额：
$ 63.69万
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 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10435533
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 ethnic minority population experimental study falls health equity health outcome disparity 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.

项目概要超过 500,000 名美国人患有透析依赖性肾衰竭，也称为终末期肾衰竭疾病（ESRD），死亡率高，发病率高，生活质量受损，并且经常发生住院和再入院。 ESRD 的负担严重落在弱势群体身上，其中少数种族/族裔人群的发病率较高，获得肾脏病治疗的机会较少，那些生活在高度贫困社区的人。覆盖范围和支付融资政策的变化医疗保险计划对 ESRD 患者获得护理和健康公平产生了重大影响人口。例如，医疗保险 (Medicare) 于 1973 年决定将承保范围扩大到患有不可逆肾病的美国人失败导致肾病死亡人数显着减少，并减少了获得医疗服务的种族差异透析。自 2021 年 1 月 1 日起，Medicare 将开放 ESRD 患者参加私人 Medicare 优势 (MA) 计划。从历史上看，患有 ESRD 的人没有资格加入 MA 计划，除非符合以下条件：有限的例外情况。 83,000 名 ESRD 患者（占 Medicare 的 ESRD 人口的 14%）预计在两年内加入 MA 计划。不幸的是，几乎没有证据可以指导政策制定者管理式护理对 ESRD 患者的后果、计划之间的差异以及对肾脏健康状况的差异。更广泛地说，过去 15 年里，硕士入学人数增加了四倍多，然而，关于管理式医疗对患有严重疾病的人的价值的基本问题仍然存在回答道。我们的长期目标是了解支付和融资变化对 ESRD 患者护理的质量、公平性和结果。这项混合方法研究是我们的下一步议程，将调查医疗保险计划将 MA 招生范围扩大到 ESRD 的影响接受透析护理、住院治疗和死亡率的人口。我们的具体目标是： 1. 审查 MA 计划通过对代表进行定性访谈来管理终末期肾病患者的护理方法来自不同地域市场的 MA 计划、透析组织和透析设施工作人员。 2. 预估扩大 MA 覆盖范围对 ESRD 患者对肾脏替代治疗模式的影响，住院率和死亡率。 3. 确定 Medicare Advantage 对 ESRD 结果影响的变化根据患者和计划的特征。该项目具有创新性，因为我们利用了前所未有的政策医疗保险计划中的实验以及跨县计划的可用性，以得出因果估计管理式护理对透析患者的影响。该项目将通过及时生产产生积极影响关于 MA 计划在为 ESRD 患者（一个具有复杂症状的人群）提供护理方面发挥作用的证据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问题，肾病学界、医疗保险计划和 2019 年优先考虑的结果关于促进美国肾脏健康的行政命令。