Project 1: Utilization, Quality, Selection and Prices in MA Going Forward

项目 1：MA 未来的利用、质量、选择和价格

• 批准号: 9335229
• 负责人: Bruce E. Landon
• 金额: $ 50.27万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9335229
• 关键词: Address; Affect; Benchmarking; Caring; Categories; Characteristics; Contracts; Cost Sharing; County; Data; Eligibility Determination; Enrollment; Expenditure; Extinction (Psychology); Face; Federal Government; Fee-for-Service Plans; Future; Health; Health Benefit; Health Personnel; Health Planning; Light; Managed Care; Measurement; Measures; Mediation; Medicaid; Medicare; Methods; Modeling; Monitor; Patients; Performance; Policies; Population; Price; Privatization; Program Efficiency; Provider; Quality of Care; Regulation; Research; Resources; Risk; Risk Adjustment; Role; Services; Sorting - Cell Movement; Structure; Surveys; System; Time; Work; base; beneficiary; design; dual eligible; experience; flexibility; health care delivery; high reward; innovation; payment; programs; retiree; risk selection; trend; willingness

PROJECT SUMMARY/ABSTRACT Even with the advent of Accountable Care Organizations (ACOs), for the foreseeable future the Medicare Advantage (MA) program is likely to remain numerically the most important alternative to Traditional Medicare (TM). Although MA currently enrolls over a quarter of Medicare beneficiaries, the reimbursement reductions ushered in by the ACA could diminish the array of supplemental benefits offered to MA beneficiaries, increase premium and cost sharing levels, and decrease the willingness of both beneficiaries and plans to participate. Moreover, many of these changes could also affect selection, the management of care, and prices private MA plans negotiate with health care providers with repercussions for the entire delivery system. Given the prominence of MA in the Medicare program, evaluating these critical aspects of MA in light of these policy changes represents an important opportunity for research. In addition, despite substantial new and important contributions by our team to the understanding of current risk adjustment methods in addressing risk selection, their adequacy in the face of the ACA's payment cuts remains an open question. This project continues our study of the provision of services, selection, and the quality of care under MA and how all of those change over time as new policies are implemented. By continuing the complementary stock and flow comparisons of health risks in the MA and TM populations that we have employed using both administrative and survey data, we will clarify how payment changes affect the performance of MA and TM. Furthermore, through the incorporation of data from Truven MarketScan as well as from several additional health plans that serve this market, we will be able to examine for the first time pricing MA plans obtain from providers and examine how those prices change over time and relate to market-level factors such as provider concentration. In short, in our current Program project we have developed methods to address the salient policy issues that MA poses, we have addressed them at a time when reimbursement was becoming more generous and MA was expanding, and now we can apply our methods to a more austere reimbursement policy in which successful ACOs may nonetheless decide to convert to MA plans.

项目概要/摘要 即使责任医疗组织 (ACO) 出现，在可预见的未来，医疗保险 从数量上看，优势 (MA) 计划可能仍然是传统医疗保险最重要的替代方案 （TM）。尽管 MA 目前登记了超过四分之一的 Medicare 受益人，但报销减少 ACA 引入的政策可能会减少向 MA 受益人提供的一系列补充福利，增加 保费和成本分摊水平，并降低受益人和计划参与的意愿。 此外，其中许多变化也可能影响私人 MA 的选择、护理管理和价格 计划与医疗保健提供者进行谈判，这会对整个交付系统产生影响。鉴于 MA 在医疗保险计划中的突出地位，根据这些政策评估 MA 的这些关键方面 变化为研究提供了重要机遇。此外，尽管有大量新的和重要的 我们的团队对理解当前风险调整方法在解决风险选择方面的贡献， 面对 ACA 的减款，它们是否足够仍然是一个悬而未决的问题。 该项目继续我们对 MA 下的服务提供、选择和护理质量的研究，以及如何 随着新政策的实施，所有这些都会随着时间的推移而发生变化。通过持续补充库存和流量 我们使用行政和管理方法对 MA 和 TM 人群的健康风险进行了比较 调查数据，我们将阐明付款变化如何影响 MA 和 TM 的绩效。此外，通过 整合来自 Truven MarketScan 以及为此服务的其他几个健康计划的数据 市场，我们将能够首次检查从供应商那里获得的 MA 计划的定价，并检查如何 这些价格随着时间的推移而变化，并与供应商集中度等市场因素有关。简而言之，在我们的 当前的计划项目，我们已经制定了解决 MA 提出的突出政策问题的方法，我们 在报销变得更加慷慨并且 MA 正在扩大的时候解决了这些问题，并且 现在我们可以将我们的方法应用到更严格的报销政策中，成功的 ACO 可能会 尽管如此，还是决定转换为 MA 计划。