Emerging Role of Medicare Advantage in Nursing Home Care

医疗保险优势在疗养院护理中的新兴作用

• 批准号: 8673221
• 负责人: Vincent Mor
• 金额: $ 44.99万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8673221
• 关键词: Acute; Affect; Caring; Characteristics; Chronically Ill; Clinical Data; Complex; Cost Savings; Data; Data Reporting; Data Set; Decubitus ulcer; Discipline of Nursing; Enrollment; Evaluation; Fee-for-Service Plans; Goals; Growth; Healthcare; Home Nursing Care; Hospitalization; ImProv; Incidence; Individual; Investigation; Knowledge; Link; Long-Term Care; Managed Care; Marketing; Medical; Medicare; Modernization; Morbidity - disease rate; Nurse Practitioners; Nursing Homes; Outcome; Patients; Policies; Population; Probability; Process; Provider; Publishing; Records; Research; Risk; Role; Services; Time; beneficiary; capitate bone; dual eligible; experience; federal policy; improved; member; mortality; nursing home length of stay; payment; programs; public health relevance; restraint

DESCRIPTION (provided by applicant): For over 25 years, Medicare policy has promoted beneficiaries' enrollment in private, risk-bearing plans, currently known as Medicare Advantage (MA) plans. The 2006 Medicare Modernization Act (MMA) increased MA payments and compensated plans for serving more medically complex and frail beneficiaries, stimulating a doubling of the MA population over the past 8 years. This explosive growth in MA enrollment has also occurred among nursing home residents; however, we know virtually nothing about the quality and outcomes of care among nursing home residents in private, managed care plans. This lack of knowledge compromises our ability to understand the implications of expansions of special needs and dual eligible MA plans included in the Affordable Care Act (ACA). Because the Medicare program spends $115 billion in annual capitated payments to MA plans, understanding their emerging role in caring for frail, chronically ill beneficiaries is critical to inform optimal federal policy. Between 2000 and 2010 the prevalent population of MA plan members in nursing homes increased from about 16,000 to 80,000 (about 8% of all long stay residents). Half of these individuals reside in only 500 nursing facilities, each with more than 75 MA plan members. United Healthcare's "Evercare" program, which provides integrated medical care and care management services to MA plan beneficiaries residing in nursing homes, was associated with lower mortality, fewer preventable hospitalizations, and cost- savings of approximately $100,000 per year per nurse practitioner. Of note, Evercare was initiated before the MMA and the subsequent growth of MA plans' use of nursing homes for post-acute and long term care patients. The long-term objective of this research is to inform policy efforts to improv the quality and outcomes of care for vulnerable nursing home residents. The objective of this application, which is the next step in our long-range goal, is to examine the impact of Medicare Advantage plans on the care of nursing home residents, both among residents enrolled in these plans as well as on non-MA residents via "spill-over" effects. The rationale that underlies this investigation is that MA plans have assumed a rapidly growing role in the care of nursing home residents with little knowledge about how managed care may impact this frail, chronically-ill population. Our central hypothesis, which is informed by the results of the Evercare evaluation and the paucity of other studies, is that integrated medical cares in the nursing home setting, particularly in facilities where MA plan residents are concentrated, positively affect patient outcomes. We propose to undertake a comprehensive examination of the growth of these plans and their impact on nursing home care using 15 years (2000 through 2014) of data on MA plans' use of nursing facilities that integrates Medicare enrollment records, HEDIS data reported to CMS, and the mandatory nursing home resident assessment minimum data set (MDS).

描述（由申请人提供）：25 年来，Medicare 政策一直在促进受益人加入私人风险承担计划，目前称为 Medicare Advantage (MA) 计划。 2006 年《医疗保险现代化法案》(MMA) 增加了 MA 付款和补偿计划，为医疗状况更复杂和体弱的受益人提供服务，刺激 MA 人口在过去 8 年翻了一番。护理院居民中也出现了 MA 入学人数的爆炸式增长；然而，我们对私人管理式护理计划中疗养院居民的护理质量和结果几乎一无所知。这种知识的缺乏损害了我们理解平价医疗法案 (ACA) 中包含的特殊需求和双重合格 MA 计划的影响的能力。由于 Medicare 计划每年向 MA 计划支付 1,150 亿美元的人均付款，因此了解其在照顾体弱的慢性病受益人方面的新兴作用对于 告知最佳联邦政策。 2000 年至 2010 年间，疗养院的 MA 计划成员人数从约 16,000 人增加到 80,000 人（约占所有长期居住居民的 8%）。其中一半人居住在仅 500 个护理机构中，每个机构都有超过 75 名护理人员 MA计划成员。 United Healthcare 的“Evercare”计划为居住在疗养院的 MA 计划受益人提供综合医疗护理和护理管理服务，该计划可降低死亡率、减少可预防的住院治疗，并且每位执业护士每年可节省约 100,000 美元的成本。值得注意的是，Evercare 是在 MMA 之前启动的，随后 MA 计划越来越多地使用疗养院来治疗急性期后和长期护理患者。 这项研究的长期目标是为政策努力提供信息，以提高弱势疗养院居民的护理质量和结果。此应用程序是我们长期目标的下一步，其目的是检查 Medicare Advantage 计划对疗养院居民护理的影响，包括参加这些计划的居民以及非 MA 居民通过“溢出”效应。这项调查的基本原理是，MA 计划在疗养院居民的护理方面发挥着迅速增长的作用，但人们对管理式护理可能如何影响这些虚弱的慢性病人群知之甚少。我们的中心假设是，基于 Evercare 评估结果和其他研究的缺乏，我们的中心假设是，疗养院环境中的综合医疗护理，特别是在 MA 计划居民集中的设施中，会对患者的治疗结果产生积极影响。我们建议使用 15 年（2000 年至 2014 年）MA 计划使用护理设施的数据（整合了 Medicare 登记记录、向 CMS 报告的 HEDIS 数据、以及强制性疗养院居民评估最低数据集（MDS）。