The Effects of Medicare Advantage on Healthcare Use and Patient Outcomes

医疗保险优势对医疗保健使用和患者结果的影响

基本信息

批准号：
10624774
负责人：
Peter Huckfeldt
金额：
$ 39.13万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10624774
关键词：
Admission activity Budgets Caring Characteristics Communities Complex Cost Sharing Data Drug Prescriptions Drug usage Elderly Emergency department visit Enrollment Fee-for-Service Plans Freedom Geographic Locations Grant Health Health Benefit Health Status Healthcare Hip Fractures Home Care Services Hospitalization Hospitals Incentives Institution Insurance Carriers Measures Medicare Myocardial Infarction Natural experiment Occupations Outcome Outpatients Patient-Focused Outcomes Patients Performance Pilot Projects Policies Policy Maker Privatization Provider Quality of Care Research Service provision Services Severities Signal Transduction Stroke Structure Telemedicine United States Centers for Medicare and Medicaid Services Variant Visit Work acute care beneficiary care providers cost design financial incentive flexibility functional status health care quality improved innovation mortality patient subsets payment prior authorization programs provider networks residence retiree tool

项目摘要

Project Summary/ Abstract A growing share of Medicare beneficiaries are enrolled in Medicare Advantage (MA) rather than traditional fee- for-service (TM) Medicare, with the MA share increasing from 13% in 2004 to 39% in 2020. The Centers for Medicare and Medicaid Services (CMS) pay MA plans a monthly capitated rate to cover nearly all health care expenses for plan enrollees. MA plans keep as profits the portion of payments that are not used to cover enrollee expenses. In addition, CMS grants MA plans greater freedom to manage enrollees’ health care use, for example, through tools such as narrow provider networks and broader coverage of delivery innovations such as telemedicine. Proponents argue that these financial incentives and effective tools for MA plans might enable them to provide care more efficiently than TM. On the other hand, these effects could be offset by financial incentives under capitation to limit service provision beyond what is necessary to improve short term health, resulting in adverse impacts on longer-term outcomes. Prior work has primarily estimated cross-sectional comparisons of TM and MA enrollees, which could lead to biased estimates if MA enrollees differ from TM enrollees in other ways that are related to health care use and health outcomes. Our proposed project will study changes in MA enrollment coming from seven states that recently changed public retiree health benefits from supplemental TM coverage to mandatory MA plans (or in one state, from a mandatory MA plan to supplemental TM coverage). We will use these natural experiments, along with comprehensive Medicare data for TM and MA enrollees, to estimate the causal impact of MA enrollment on health care use, quality, and patient outcomes. These results will provide important evidence to policymakers weighing broader expansions of Medicare Advantage.

项目摘要/摘要越来越多的医疗保险受益人被纳入Medicare Advantage（MA），而不是传统的费用 - 服务（TM）Medicare，MA份额从2004年的13％增加到2020年的39％。 Medicare和Medicaid Services（CMS）付费MA计划每月大写的费率，以支付几乎所有医疗保健计划参与者的费用。 MA计划将不用于覆盖注册的付款的部分保留开支。此外，CMS授予MA计划更大的自由来管理注册的医疗保健使用，例如通过狭窄的提供商网络等工具，以及更广泛的交付创新范围远程医疗。支持者认为，这些财务激励措施和有效的MA计划工具可能会启用他们比TM更有效地提供护理。另一方面，这些效果可能会被财务所抵消资本化的激励措施将服务提供的规定限制在改善短期健康所必需的之外，导致对长期结局的不利影响。先前的工作具有主要估计的横截面 TM和MA注册的比较，如果MA与TM不同，则可能导致估计值以其他与医疗保健使用和健康成果相关的方式注册。我们提议的项目将研究来自七个州的MA入学变化最近改变了公共退休人员健康益处补充TM覆盖强制性MA计划（或在一个州，从强制性MA计划到补充计划 TM覆盖范围）。我们将使用这些自然实验，以及用于TM和MA的全面Medicare数据注册，以估算MA入学对医疗保健使用，质量和患者结果的因果影响。这些结果将为政策制定者提供重要的证据优势。