Medicaid Payment Policy and Access to Care for Dual Eligible Beneficiaries

双重合格受益人的医疗补助付款政策和获得护理的机会

• 批准号: 9768326
• 负责人: Vicki Fung
• 金额: $ 35.55万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768326
• 关键词: Medicaid; Payment; Policy; Access; Care

ABSTRACT This project will assess the impact of primary care provider (PCP) payment policy on outpatient care, clinical events, and medical spending. This project focuses on dual-eligible Medicare-Medicaid beneficiaries, as they are among the most costly and clinically vulnerable individuals in both programs and have historically had suboptimal access to care. We will assess the effects of temporary increases in Medicaid payment rates for PCPs in 2013 and 2014 that were mandated by the Affordable Care Act (ACA); this policy increased PCP payments for dual-eligible beneficiaries by up to 25 percent. The intent of the policy was to improve access to primary care for low-income populations, especially given large expected increases in the number of individuals covered by private insurance and Medicaid coverage due to the ACA. While one study found increased PCP appointment availability associated with the higher payments, there is little evidence on the effects of the policy on actual utilization, clinical outcomes, or total spending. Despite the limited evidence, most states returned to pre-2013 Medicaid payment rates in 2015, while 16 states continued the payment increase. We will examine the association between PCP payment changes and three types of outcomes: 1) outpatient care, including PCP visits and sentinel quality measures; 2) clinical events, including emergency department visits, preventable hospitalizations, and mortality; and 3) total and component medical spending. Our primary analyses will use Medicare claims data for low-income beneficiaries (N=1.48 million in 2011) from 2011-2017 linked with supplemental data on providers and individual- and area-level characteristics. We will use a quasi-experimental difference-in-difference design with fixed effects (within-person) estimation approaches to compare (1) dual-eligibles with incomes ≤100% of the federal poverty level (FPL) for whom PCP payments increased (policy intervention group) with (2) a concurrent control group of low-income (101-135% FPL) non-dual Medicare beneficiaries without payment changes who live in the same geographic areas. We will examine variation in outcomes for beneficiaries living in states that did and did not expand Medicaid, and did and did not continue the payment increase after 2014. We will also conduct supplemental analyses using the Massachusetts All-Payer Claims Database to examine outcomes for all Medicaid enrollees in the state (with and without Medicare). In short, we will use the natural experiment created by the ACA and comprehensive datasets to provide timely information on the impact of increasing provider payments for low- income patients, with a focus on vulnerable dual-eligibles. Information on the potential effects of this policy is urgently needed as the federal government and states are continuing to make ongoing decisions regarding provider payment policy.

抽象的 该项目将评估初级保健提供商（PCP）支付政策对门诊护理，临床的影响 活动和医疗支出。该项目着重于双重资格的Medicare Medicaid受益人 在这两个计划中都是最昂贵和临床上最脆弱的人之一 次优访问护理。我们将评估医疗补助支付率暂时增加的影响 2013年和2014年由《平价医疗法案》（ACA）授权的PCP；这项政策增加了PCP 对双重资格受益人的付款高达25％。该政策的目的是提高对 低收入人群的初级保健，特别是考虑到大量预期数量 由于ACA而受到私人保险和医疗补助覆盖的个人。一项研究发现 与较高付款相关的PCP预约可用性增加，几乎没有证据表明 政策对实际利用，临床结果或总支出的影响。尽管证据有限 大多数州于2015年返回2013年以前的医疗补助付款率，而16个州继续付款 增加。我们将研究PCP支付变化与三种结果之间的关联：1） 门诊护理，包括PCP访问和前哨质量措施； 2）包括紧急事件 部门访问，可预防的住院和死亡率； 3）总和组件医疗支出。 我们的主要分析将对低收入受益人使用Medicare索赔数据（2011年n = 148万） 2011 - 2017年与提供者以及个人和地区级特征的补充数据相关。我们将 使用带有固定效果（人身内部）估计的准实验差异差异设计 比较（1）双重宗教与收入≤100％的联邦贫困水平（FPL）的方法 付款增加（政策干预小组），（2）同时对照组的低收入组（101-135％ fpl）非二线医疗保险受益人，没有付款改变，他们生活在同一地理区域。我们 将研究居住在做过也没有扩大医疗补助的州的受益人的成果差异， 确实并且没有在2014年之后继续付款。我们还将使用 马萨诸塞州全付款人声称数据库要检查该州所有医疗补助的结果 （有和没有医疗保险）。简而言之，我们将使用ACA创建的自然实验 全面的数据集，以及时提供有关增加提供商付款对低 - 的影响的信息 收入患者，专注于脆弱的双重盗用。有关该政策潜在影响的信息是 由于联邦政府和各州正在继续做出关于 提供者付款政策。