The impact of Medicare Advantage on Health Care, Management of Comorbid Conditions, and Potentially Inappropriate Medication Use, for Beneficiaries with Alzheimer's Disease and Its Related Dementias

医疗保险优势对阿尔茨海默病及其相关痴呆症受益人的医疗保健、共病管理以及潜在不适当药物使用的影响

• 批准号: 10525172
• 负责人: Victoria Shier
• 金额: $ 66.56万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525172
• 关键词: Adult; Alzheimer' s Disease; Alzheimer' s disease related dementia; Caring; Characteristics; Chronic; Chronic Disease; Communities; Complex; Cost Control; Data; Dementia; Disease Management; Drug Prescriptions; Enrollment; Geographic Locations; Growth; Health; Health Benefit; Health Services; Health Status; Healthcare; Hospitalization; Hospitals; Impaired cognition; Incentives; Individual; Inpatients; Institutionalization; Knowledge; Lead; Long-Term Care; Medical; Medicare; Natural experiment; Nursing Homes; Outcome; Outpatients; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Polypharmacy; Population; Prevention; Preventive service; Privatization; Quality of Care; Research; Services; Social Work; Time; Variant; Visit; Vulnerable Populations; adverse drug reaction; base; beneficiary; care coordination; comorbidity; cost; financial incentive; health care delivery; health care service utilization; health management; health service use; improved; insight; meetings; patient subsets; payment; programs; retiree; satisfaction; service providers; tool; treatment adherence

Project Summary / Abstract Over 6 million adults in the U.S. are living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (ADRD), a population estimated to double by 2050. Medicare costs associated with individuals with AD/ADRD are more than three times higher than for those without and the total Medicare spending for beneficiaries with AD/ADRD is projected to reach $584 billion in 2050. People with ADRD are also characterized by higher complexity of comorbid conditions and coordination of care. There is evidence of potentially inappropriate or suboptimal care for individuals with ADRD. Medicare Advantage (MA) provides a potential opportunity to improve the efficiency and quality of treatment for individuals with ADRD. Because MA plans receive capitated monthly payments from Medicare, they have strong financial incentive to manage chronic conditions and avoid unnecessary health care use. However, MA plans' incentives to control costs could also lead to reduction in beneficial care for enrollees with AD/ADRD. Prior research suggest that MA enrollment is associated with lower healthcare utilization for ADRD individuals, but the results were based on cross-sectional comparisons in self-reported outcomes between MA and TM, which could have biased estimates if MA enrollees differed from TM enrollees in unobserved ways. With the growing share of Medicare beneficiaries enrolled in MA, it is important to understand the causal effects of MA coverage on health care use and outcomes for beneficiaries with ADRD. Our proposed project will use plausibly exogenous variation in MA enrollment in seven states that shifted public retiree health benefits from TM with supplemental plans to mandatory MA plans (or in one state, from a mandatory MA plan to TM coverage) in 2016-2019. We will use these natural experiments, along with comprehensive Medicare data for TM and MA enrollees, to estimate the causal effects of MA coverage on health care use, management of comorbid conditions, potentially inappropriate medication use and polypharmacy, and institutionalization for individuals with ADRD. These results will provide insights on the relative benefits and harms of MA enrollment for this vulnerable population and contribute important evidence to policymakers weighing broader expansions of Medicare Advantage.

项目概要/摘要 美国有超过 600 万成年人患有阿尔茨海默病和阿尔茨海默病 相关痴呆症 (ADRD) 人口预计到 2050 年将增加一倍。 医疗保险费用 与患有 AD/ADRD 的人相关的比例是那些人的三倍多 没有 AD/ADRD 的受益人的医疗保险总支出预计将达到 2050 年将达到 5840 亿美元。ADRD 患者的共病复杂性也更高 护理条件和协调。有证据表明可能存在不适当或次优的情况 照顾 ADRD 患者。 Medicare Advantage (MA) 提供了一个潜在的机会 提高 ADRD 患者的治疗效率和质量。因为MA计划 每月从医疗保险中获得按人头支付的款项，他们有强烈的经济动机 管理慢性病并避免不必要的医疗保健使用。然而，MA 计划 控制成本的激励措施也可能导致对患有以下疾病的参与者的有益护理的减少 AD/ADRD。先前的研究表明，硕士入学与较低的医疗保健水平有关 ADRD 个体的利用率，但结果是基于横断面比较 MA 和 TM 之间的自我报告结果，如果 MA 注册者与 TM 注册者有一些未观察到的差异。随着医疗保险份额的不断增加 参加 MA 的受益人，了解 MA 覆盖范围对 MA 的因果影响非常重要 ADRD 受益人的医疗保健使用和结果。我们提议的项目将使用 七个州 MA 入学率的外生变化改变了公共退休人员的健康状况 从带有补充计划的 TM 到强制性 MA 计划（或在一个州，从 2016-2019 年强制性 MA 计划（TM 覆盖范围）。我们将利用这些自然实验， 以及 TM 和 MA 参与者的综合医疗保险数据，以估计因果关系 MA 覆盖范围对医疗保健使用、合并症管理的潜在影响 不适当的药物使用和多重用药，以及将患有此病的个人送入收容机构 ADRD。这些结果将提供有关硕士入学的相对好处和坏处的见解 为这一弱势群体提供重要证据，供决策者权衡 医疗保险优势的更广泛扩展。