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.

项目概要/摘要 拟议的研究将是第一个分解不同机构、州和患者层面的研究 干扰具有双重资格的老年人获得医疗保险和医疗补助的因素 （“双重”）记忆护理，并就如何解决问题提供可操作的、针对具体州的政策指导 这些障碍患有阿尔茨海默病（AD）和相关痴呆症（ADRD）的风险较高， 鉴于他们的收入和教育程度较低，以及慢性病患病率较高和管理较差 由于享有部分医疗补助，双子女面临着众所周知的医生不愿看病的情况。 他们，因为与仅医疗保险受益人相比，支付率较低，并且 鉴于提供者需要分别向医疗补助和医疗保险计费，管理复杂性。 水平因素，例如驾驭两个独立福利计划的能力有限，加剧了这一挑战。 经过测试，双重人格不太可能因认知障碍而被诊断、咨询和治疗 尽管他们的疾病负担较高，但缓解疾病的 AD 治疗方法可能会出现。 很快，理解和解决这些障碍就变得紧迫，以避免潜在的扩大 拟议的研究有三个目标： 调查相似预测的对偶之间接受记忆护理方面差异的关联 患者（例如种族/民族）和州级因素（例如提供者）导致认知障碍的风险 密度）。 因果分解医生付费率、患者导航和行政管理的影响 与具有相似认知的非二元论者相比，二元论者访问记忆护理的复杂性 我们将利用各州医疗补助费率的差异和 2022 年政策。 旨在改善患者导航并降低医生管理复杂性的改革。 探讨医生付费率、患者导航和管理复杂性是否会产生影响 获得记忆护理的机会由患者和州层面的差异驱动因素调节，并提供 关于如何有效和高效地改善记忆访问的量身定制和可操作的政策指导 照顾所有 50 个州和哥伦比亚特区的双打。