Passive Enrollment Of Dual-Eligible Beneficiaries Into Medicare And Medicaid Managed Care Has Not Met Expectations
Passive Enrollment Of Dual-Eligible Beneficiaries Into Medicare And Medicaid Managed Care Has Not Met Expectations
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DOI：
10.1377/hlthaff.2016.1082
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发表时间：
2017-05-01
期刊：
影响因子：
9.7
通讯作者：
Frank, Richard G.
中科院分区：
文献类型：
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作者：
Grabowski, David C.;Joyce, Nina R.;Frank, Richard G.
医疗保险和医疗补助服务财务协调中心倡议是迄今为止最大的努力，旨在通过使用被动(自动)登记将同时有资格享受联邦医疗保险和医疗补助的受益人-称为双重合格人员-转移到协调的护理模式中。13个州正在测试综合支付和交付示范计划，估计有130万符合双重资格的人有资格参与。截至2016年10月，被动注册已将30多万符合双重资格的人带入了8个州的9个大写项目。然而，项目参与水平仍然相对较低。在这八个州中，只有26.7%的有资格参加的双胞胎学生被录取，从纽约州两个项目的5.3%到俄亥俄州的62.4%不等。尽管我们观察到，在被动入学的符合条件的双学位学生中，退学率和退学率高的确切原因尚不清楚，但迄今的经验表明，行政挑战与入学的需求和供应方面的障碍相结合。这些早期的发现引发了人们的疑问，即被动登记是否可以鼓励符合条件的双重条件者参与综合护理模式。
The Centers for Medicare and Medicaid Services Financial Alignment Initiative represents the largest effort to date to move beneficiaries who are eligible for both Medicare and Medicaid-known as dual eligibles-into a coordinated care model by the use of passive (automatic) enrollment. Thirteen states are testing integrated payment and delivery demonstration programs in which an estimated 1.3 million dual eligibles are qualified to participate. As of October 2016, passive enrollment had brought over 300,000 dual eligibles into nine capitated programs in eight states. However, program participation levels remained relatively low. Across the eight states, only 26.7 percent of dual eligibles who were qualified to participate were enrolled, ranging from 5.3 percent for the two New York programs together to 62.4 percent in Ohio. Although the exact causes of the high rates of opting out and disenrolling that we observed among passively enrolled dual eligibles are unknown, experience to date suggests that administrative challenges were combined with demand-and supply-side barriers to enrollment. These early findings draw into question whether passive enrollment can encourage dual eligibles to participate in integrated care models.