The effects of plan payment rates on the market for Medicare Advantage Dual-Eligible Special Needs Plans
The effects of plan payment rates on the market for Medicare Advantage Dual-Eligible Special Needs Plans
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DOI：
10.1111/1475-6773.13170
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发表时间：
2019-10-01
影响因子：
3.4
通讯作者：
Grabowski, David C.
中科院分区：
文献类型：
--
作者：
McGarry, Brian E.;Layton, Timothy J.;Grabowski, David C.
目的确定更高的潜在基准支付率对医疗保险优势（MA）双重资格特殊需求计划（D-SNP）市场的影响。数据来源/研究设置2009年至2015年公开的县级数据，涉及该县内运行的D-SNP数量，这些计划的入学率和五星级评分质量，以及用于确定资本计划付款的基准金额。研究设计本研究利用2012年引入的质量奖金支付的MA计划，这些奖金的潜在规模的外生地理差异，以估计基准支付增加对可用性，质量和D-SNPs的吸收的影响。我们使用差异中的差异估计方法来比较有资格获得双倍奖金的县与没有资格获得双倍奖金的县的D-SNP市场的变化。奖金加倍与提供的D-SNPs数量相对增加29%（P = 0.021）和可用D-SNPs平均质量增加0.1-星星（P = 0.034）相关。未检测到总体D-SNP招募的相对增加。结论这些研究结果表明，较大的基准支付金额可能会影响保险公司的决定是否参与D-SNP市场，但不双杀决定是否参加这些计划。未来的研究需要为D-SNPs是否是一种整合双重杀伤效应的可行机制以及医疗保险政策应在多大程度上支持其持续增长的讨论提供信息。
Objective To determine the effect of higher potential benchmark payment rates on the market for Medicare Advantage (MA) Dual-Eligible Special Needs Plans (D-SNPs). Data Sources/Study Setting Publicly available county-level data from 2009 to 2015 regarding the number of D-SNPs operating within the county, the enrollment in and five-star quality of score of these plans, and the benchmark amounts used to determine capitated plan payments. Study Design This study exploits the introduction of quality bonus payments to the MA program in 2012, and exogenous geographic variation in the potential size of these bonuses to estimate the effect of benchmark payment increases on the availability, quality, and take-up of D-SNPs. We use a difference-in-difference estimation approach to compare changes in the market for D-SNPs in counties eligible for a double bonus to those that are not. Principal Findings The doubling of bonuses was associated with a relative 29 percent increase in the number of D-SNPs offered (P = 0.021) and 0.1-star increase in the average quality of available D-SNPs (P = 0.034). No relative increase in overall D-SNP enrollment was detected. Conclusions These findings indicate that larger benchmark payment amounts may influence insurers' decisions of whether to participate in the D-SNP market but not dual-eligibles' decision of whether to enroll in these plans. Future research is needed to inform discussions about whether D-SNPs are a viable mechanism for integrating benefits for dual eligibles and the degree to which Medicare policies should support their continued growth.