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.

项目摘要 /摘要 美国有超过600万成年人患有阿尔茨海默氏病和阿尔茨海默氏病 相关痴呆症（ADRD），估计到2050年的人口估计翻倍。医疗保险费用 与AD/ADRD的个体相关的人比那些人高三倍以上 预计没有AD/ADRD的受益人的医疗保险支出总计 2050年5840亿美元。ADRD的人的特征也具有更高的合并症 条件和护理协调。有可能不适当或次优的证据 照顾有ADRD的人。 Medicare Advantage（MA）提供了潜在的机会 提高ADRD患者的治疗效率和质量。因为马计划 收到Medicare的每月支付，他们有强烈的经济激励措施 管理慢性病并避免不必要的医疗保健使用。但是，马计划 控制成本的激励措施也可能导致参与者的有益护理减少 广告/adrd。先前的研究表明，MA入学率与较低的医疗保健有关 ADRD个人的利用，但结果是基于横截面比较的 MA和TM之间的自我报告的结果，如果MA，这可能会有偏见 参与者以未观察到的方式与TM参与者不同。随着Medicare的份额不断增长 受益人入学了MA，重要的是要了解MA覆盖范围的因果影响 ADRD的受益人的医疗保健使用和成果。我们提议的项目将使用 在七个转移公共退休人员健康的七个州，MA入学的外源性变化很明显 TM从具有补充计划的TM受益（或在一个州，从一个州中， 2016 - 2019年的强制性MA计划）。我们将使用这些自然实验， 以及用于TM和MA参与者的全面Medicare数据，以估计因果关系 MA覆盖范围对医疗保健使用的影响，合并状况的管理 不适当的药物使用和一多药，以及对患有的人的制度化 adrd。这些结果将为MA入学的相对利益和危害提供见解 对于这个脆弱的人口，并为权衡的决策者提供重要证据 医疗保险优势的广泛扩展。