Medicare and Beneficiaries with Dementia

医疗保险和痴呆症受益人

• 批准号: 10196906
• 负责人: DAVID C GRABOWSKI
• 金额: $ 29.6万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10196906
• 关键词: Accounting; Address; Aging; American; Area; Caring; Case Mixes; Chronic Care; Chronic Obstructive Airway Disease; Clinical; Code; Cognition; Cognitive; Cognitive deficits; Complex; Data; Data Set; Data Sources; Dementia; Diabetes Mellitus; Diagnosis; Diffusion; Disease; Enrollment; Epidemiologist; Event; Family; Fee-for-Service Plans; Fee-for-Service Reimbursements; Geriatric Psychiatry; Health; Health and Retirement Study; Heart failure; Home; Impaired cognition; Incentives; Individual; Internal Medicine; Investigation; Link; Medicaid; Medical; Medicare; Medicare claim; Methods; Modeling; Morbidity - disease rate; Neurology; Outcome; Patients; Penetration; Pharmaceutical Preparations; Physicians; Policies; Population; Predisposition; Probability; Psychoses; Reference Standards; Research; Research Personnel; Risk; Risk Adjustment; Role; Sampling; Services; Severities; Severity of illness; Skilled Nursing Facilities; Sorting - Cell Movement; Standardization; Supportive care; Surveys; System; Variant; Weight; Work; base; beneficiary; care outcomes; cognitive ability; cognitive function; comorbidity; dementia care; design; dual eligible; efficacious treatment; flexibility; frailty; health data; improved; incentive program; medical specialties; payment; predictive modeling; programs; provider networks; research study; trend

ABSTRACT Millions of Americans have or will develop dementia, which has potentially dire implications for them, their families, and the Medicare program. Beneficiaries with dementia already account for an estimated one in five dollars of Medicare spending, yet the Medicare program has struggled to meet their complex medical and supportive needs. Researchers' efforts to describe and improve the care Medicare beneficiaries with dementia receive have been hampered by the difficulty of identifying those with dementia or cognitive impairments in claims data, yet such data are currently the only data on Medicare beneficiaries that are available on a large scale. Prior studies suggest that many beneficiaries have undetected or undiagnosed disease, while others with intact cognition carry a false claims-based diagnosis. Accordingly, our first aim is to leverage linked survey and claims data to predict the probability of dementia and its severity, according to a validated, survey-based reference standard. Better identification of those with dementia is a prerequisite to obtain a more accurate national picture of the care for this important population. The two data sources are also complementary; survey data help assess under-diagnosis and the probability that a claim-based diagnosis truly represents dementia, and claims data supports the examination of Medicare programs at scale. We will then describe the sorting of Medicare beneficiaries across available plan options: Traditional Medicare (TM), Medicare Advantage (MA), and within MA, Special Needs Plans (SNPs). This work builds on our existing P01 research on choice, which demonstrated that beneficiaries with less cognitive ability were more likely to choose a dominated plan. In this project, we will examine sorting with respect to options potentially advantageous for those with dementia, e.g., SNPs. Finally, we will examine dementia care and outcomes in the changing Medicare program as both payments for dementia beneficiaries and benefit flexibility increase. For example, MA plans will receive substantially larger payments for enrolled beneficiaries with dementia starting in 2020 through risk adjustment formula changes, which coincides with new flexibility in offering LTSS because of the CHRONIC Care Act. Additionally, reimbursement of skilled nursing facilities will change in late 2019 to weigh cognitive deficits more and therapy minutes less. Our study will provide critically needed evidence about the role of incentives and program flexibility for beneficiaries with dementia receiving care within Medicare in an era of change.

抽象的 数以百万计 家庭和医疗保险计划。患有痴呆症的受益人已经说明了大约五分之一 美元的医疗保险支出，但是Medicare计划一直在努力满足其复杂的医疗和 支持需求。研究人员为描述和改善痴呆症的医疗保险受益人的努力 受到识别痴呆症或认知障碍的人的困难，受到了阻碍 索赔数据，但是这些数据目前是医疗保险受益人的唯一数据 规模。先前的研究表明，许多受益人没有发现或未诊断出疾病，而其他受益人则 完整的认知带有基于索赔的诊断。因此，我们的第一个目的是利用链接的调查 并声称数据以预测痴呆症的可能性及其严重性，根据经过验证的，基于调查的概率 参考标准。更好地识别痴呆症患者是获得更准确的先决条件 国家照顾这个重要人群的国家图片。这两个数据源也是互补的。民意调查 数据帮助评估诊断不足以及基于索赔的诊断真正代表痴呆的可能性， 并索赔数据支持大规模检查Medicare计划。然后，我们将描述分类 可用计划选项的Medicare受益人：传统医疗保险（TM），Medicare Advantage（MA）， 在MA中，特殊需求计划（SNP）。这项工作建立在我们现有的P01选择研究的基础上， 证明认知能力较低的受益人更有可能选择一个主导的计划。在这个 项目，我们将研究有关痴呆症患者可能有利的选择的分类，例如 SNP。最后，我们将研究不断变化的Medicare计划中的痴呆症护理和结果 痴呆受益人的付款和利益灵活性提高。例如，MA计划将收到 从2020年开始，通过风险调整开始，痴呆症的入学受益人的付款要大得多 公式变化，这与新的灵活性相吻合，在提供LTSS的新灵活性中，由于《慢性护理法》。 此外，熟练护理设施的报销将在2019年末变化，以权衡认知缺陷 和治疗分钟少。我们的研究将提供有关激励措施和 在变革时代，在医疗保险中接受痴呆症的受益人的计划灵活性。