Policy options to improve access to memory care for disadvantaged individuals who are dually eligible for Medicare and Medicaid

改善具有医疗保险和医疗补助双重资格的弱势群体获得记忆护理的政策选择

• 批准号: 10729830
• 负责人: Soeren Mattke
• 金额: $ 53.63万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729830
• 关键词: Abnormal coordination; Accounting; Address; Adopted; Alzheimer' s Disease; Alzheimer' s disease related dementia; Cardiovascular Diseases; Caring; Characteristics; Chronic; Chronic Disease; Consultations; Cost Sharing; Counseling; Data; Dementia; Demography; Diabetes Mellitus; Diagnosis; Disease; Disparity; Disparity population; District of Columbia; Education; Educational Status; Elderly; Equilibrium; Ethnic Origin; Event; Face; Failure; Geography; Health Services Accessibility; Heterogeneity; High Prevalence; Impaired cognition; Impairment; Improve Access; Individual; Institution; Intervention; Low income; Measures; Medicaid; Medicare; Medicare Part B; Medicare/Medicaid; Modeling; Patients; Physicians; Policies; Policy Maker; Process; Provider; Race; Recommendation; Risk; Risk Factors; Scheme; Services; Smoking; Specialist; System; Transportation; Variant; Visit; Wait Time; Work; access disparities; aged; beneficiary; burden of illness; care systems; cognitive testing; copayment; dementia risk; density; dual eligible; ethnic minority; falls; health literacy; high risk; human old age (65+); improved; insight; medical specialties; memory care; multiple chronic conditions; patient navigation; payment; racial minority; risk prediction; sex

Project Summary/Abstract The proposed study will be the first to decompose how different institutional-, state- and patient-level factors interfere with the access of elderly individuals dually eligible for Medicare and Medicaid (“duals”) to memory care and provide actionable and state-specific policy guidance on how to address these obstacles. Duals have a higher risk of Alzheimer’s disease (AD) and related dementias (ADRD), given their lower income and education, as well as higher prevalence and worse management of chronic conditions. Having partial Medicaid coverage, duals face the well-known reluctance of physicians to see them, because of lower payment rates compared to those for Medicare-only beneficiaries, and administrative complexity given that providers need to bill Medicaid and Medicare separately. Patient- level factors, such as limited ability to navigate two separate benefit schemes, compound the challenge. Consequently, duals are less likely to be diagnosed, counseled, and treated for cognitive impairment in spite of their higher disease burden. As disease-modifying AD treatments are likely to become available soon, understanding and addressing these obstacles becomes pressing to avoid potentially widening existing disparities. The proposed study has three aims: Investigate the association of disparities in receiving memory care between duals of similar predicted risk of cognitive impairment with patient- (e.g., race/ethnicity) and state-level factors (e.g., provider density). Causally decompose the effects of physician payment rates, patient navigation, and administrative complexity on access to memory care for duals compared to non-duals with similar cognitive impairment risk. We will take advantage of differences in Medicaid rates across states and a 2022 policy reform that aims to improve patient navigation and reduce administrative complexity for physicians. Explore whether effects of physician payment rates, patient navigation, and administrative complexity on access to memory care are moderated by patient- and state-level drivers of disparities, and provide tailored and actionable policy guidance on how to effectively and efficiently improve access to memory care for duals to all 50 states and the District of Columbia.

项目摘要/摘要 拟议的研究将是第一个分解不同机构，状态和患者级别的研究 因素干扰了基本人的访问，有资格获得Medicare和Medicaid （“双重”）记忆护理，并提供有关如何解决的可行和特定国家的政策指导 这些障碍。双重患阿尔茨海默氏病（AD）和相关痴呆症（ADRD）的风险更高， 鉴于他们的收入和教育较低，以及慢性的较高流行和较差的管理 状况。双重医疗补助覆盖范围，双重偶然面临着医生的众所周知 与仅医疗保险受益人相比，他们的付款率较低，并且 鉴于提供者需要单独向医疗补助和医疗保险账单，行政复杂性。病人- 级别因素（例如有限的两个单独的福利计划能力）加剧了挑战。 因此，对双重的认知障碍的诊断，结识和治疗的可能性较小 疾病负担较高。随着改良疾病的广告处理可能会可用 很快，理解和解决这些障碍变得紧迫，以避免潜在地扩大 现有分布。拟议的研究有三个目的： 研究分布在接收记忆护理的相似双重预测之间的记忆护理中的关联 患者（例如种族/种族）和州级因素（例如提供者 密度）。 因果分解物理支付率，患者导航和行政的影响 与具有相似认知的非对偶相比，访问双重记忆护理的复杂性 损害风险。我们将利用各州的医疗补助率差异和2022年的政策 旨在改善患者导航并降低医生的行政复杂性的改革。 探索物理支付率，患者导航和行政复杂性的影响是否 在获得记忆护理时 针对如何有效有效地改善对记忆的访问的量身定制且可行的政策指导 照顾所有50个州和哥伦比亚特区的双人双重。