Use of post-acute care and outcomes among Medicare Advantage and fee-for-service beneficiaries

Medicare Advantage 和按服务收费受益人对急性后护理的使用和结果

• 批准号: 10390350
• 负责人: Robert Edward Burke
• 金额: $ 34.11万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10390350
• 关键词: Use; post; acute; care; outcomes

Project summary Post-acute care (PAC) is common, and costly, and may not lead to optimal health outcomes for older adults. However, it is unknown how to improve outcomes and/or lower costs, or value, of PAC. More than 40% of Medicare fee-for-service (FFS) beneficiaries receive PAC after hospitalization, predominantly in skilled nursing facilities (SNFs) and by home health (HH) agencies, at a cost of more than $60 billion annually. Unfortunately, around 1 in 4 is readmitted to the hospital within 30 days of discharge to PAC, and nearly half of beneficiaries in SNF fail to return to the community within 100 days of hospital discharge. The rapid expansion of Medicare Advantage (MA) provides an opportunity to evaluate a different approach to PAC utilization. More than one- third of all Medicare beneficiaries are now enrolled in Medicare Advantage (MA) plans, which receive capitated payments and take financial risk for the care needs of beneficiaries. MA plan directors confirm in interviews that PAC is a major focus of efforts to reduce care utilization and costs through four mechanisms: limiting use of PAC overall; steering beneficiaries to less expensive forms (HH) instead of more expensive forms (SNF); restricting choice of providers; and limiting PAC length of stay. Early reports suggest MA plans may strongly influence PAC utilization. Whether reductions in PAC utilization in MA improve PAC value is unknown. The limited existing literature has two main gaps: first, it does not adequately account for the substantial underlying differences in the MA and FFS populations. Second, it has focused on short-term outcomes, while PAC likely has a substantial impact on longer-term functional status and independence. Our overall goal is to inform patients, providers, and policymakers about ways to improve the value of PAC for all Medicare beneficiaries. To achieve this goal, we propose innovative analytic strategies that address limitations in the prior literature and allow accurate assessment of the use and outcomes of PAC in similar MA and FFS beneficiaries. Our aims are to: 1) Compare use of SNF and HH in similar MA and FFS beneficiaries after hospital discharge, and the impact of different mechanisms for limiting PAC utilization; 2) Compare PAC outcomes (community days, long-term institutionalization, rehospitalization, mortality) at 100 days and 1 year after hospital discharge in MA and FFS; and 3) Evaluate the effects of MA versus FFS enrollment on specific subpopulations of patients known to be at high risk for poor PAC outcomes. These results will provide novel insights into the effect of MA plans on PAC use and outcomes, identifying potential benefits or unintended consequences that can shape policy.

项目摘要 急性后护理（PAC）很普遍，而且昂贵，并且可能不会为老年人带来最佳的健康状况。 但是，未知如何改善PAC的结果和/或较低的成本或价值。超过40％ 医疗保险费用服务（FFS）受益人在住院后接受PAC，主要是熟练的护理 设施（SNF）和家庭健康（HH）机构，每年的费用超过600亿美元。很遗憾， 大约四分之一的人在出院后的30天内被送往医院，受益人近一半 在SNF中，在出院后的100天内未能返回社区。医疗保险的快速扩张 优势（MA）提供了评估PAC利用方法的不同机会。超过一个 现在，所有Medicare受益人中的第三名都参加了Medicare Advantage（MA）计划，该计划接受了投票 付款并承担受益人的护理需求的财务风险。 MA计划导演在面试中确认 PAC是通过四种机制降低护理利用和成本的主要努力：限制使用 PAC总体上；将受益人转向较便宜的形式（HH），而不是更昂贵的形式（SNF）； 限制提供者的选择；并限制PAC的住宿时间。早期的报告表明，MA计划可能强烈 影响PAC利用。 MA中PAC利用率的降低是否改善PAC值尚不清楚。这 有限的现有文献有两个主要差距：首先，它不能充分说明实质性的基础 MA和FFS种群的差异。其次，它专注于短期成果，而PAC可能 对长期功能状况和独立性有重大影响。我们的总体目标是告知 患者，提供者和政策制定者关于提高所有医疗保险受益人的PAC价值的方法。 为了实现这一目标，我们提出了创新的分析策略，以解决先前文献中的局限性 并允许在类似的MA和FFS受益人中准确评估PAC的使用和结果。我们的 目的是：1）比较出院后类似的MA和FFS受益人中使用SNF和HH的使用，以及 不同机制限制PAC利用的影响； 2）比较PAC结果（社区日， 长期制度化，重新住院，死亡率）在医院出院后100天及以后 和FFS； 3）评估MA与FFS入学对患者特定亚群的影响 众所周知，PAC结局不佳。这些结果将为MA的影响提供新的见解 关于PAC使用和结果的计划，确定可能塑造的潜在收益或意外后果 政策。