Effects of Expanding Medicare Advantage Enrollment toPersons with End-stage Renal Disease

项目摘要 超过500，000名美国人患有透析依赖性肾衰竭，也称为终末期肾衰竭， 终末期肾病（ESRD）的死亡率高，发病率高，生活质量受损， 住院和再入院。ESRD的负担沉重地福尔斯在弱势群体身上， 少数种族/族裔人群的发病率较高，获得肾脏病治疗的机会较少， 那些生活在高贫困社区的人。2004 - 2005两年期覆盖面和支付融资政策的变化 医疗保险计划对ESRD患者获得护理和健康公平性产生了重大影响 人口例如，1973年，医疗保险决定将覆盖范围扩大到患有不可逆肾脏疾病的美国人， 失败导致肾脏疾病死亡率显著下降，并减少了获得肾脏疾病治疗的种族差异。 透析自2021年1月1日起，医疗保险将开放ESRD患者在私人医疗保险中的注册 优势（MA）计划。从历史上看，ESRD患者没有资格参加MA计划，除非根据 有限的例外。8.3万ESRD患者（占医疗保险ESRD人群的14%） 预计在两年内加入MA计划。不幸的是，几乎没有证据可以指导政策制定者 管理式护理对ESRD患者的后果，计划之间的差异，以及对 肾脏健康的差异。更广泛地说，在过去的15年里，MA入学人数增加了四倍多， 然而，对于严重健康状况的人来说，管理式护理的价值仍然存在根本问题 回答我们的长期目标是了解支付和融资变化对 终末期肾病患者护理的质量、公平性和结果。这种混合方法的研究，我们的下一步 议程，将调查医疗保险计划的硕士招生扩大到ESRD的影响 接受透析治疗的人口、住院人数和死亡率。我们的具体目标是：1.审查千年评估计划“ 通过对代表进行定性访谈来管理ESRD患者护理的方法 来自不同地理区域市场的MA计划、透析组织和透析机构工作人员。2.估计 将MA覆盖范围扩大到ESRD患者对肾脏替代治疗模式的影响， 住院和死亡率。3.确定Medicare Advantage对ESRD结局影响的差异 患者和计划的特点。该项目是创新的，因为我们利用了前所未有的政策 医疗保险计划的实验和跨县计划的可用性，以得出因果估计， 管理式护理对透析患者的影响。该项目将产生积极的影响，及时 关于MA计划在为ESRD患者提供护理方面的作用的证据， 健康需求和社会风险因素。我们关注生存率、住院率和家庭透析的使用， 肾脏病学社区，医疗保险计划和2019年优先考虑的结果 关于促进美国肾脏健康的行政命令。

Project Summary The over 500,000 Americans with dialysis-dependent kidney failure, also known as end-stage renal disease (ESRD), suffer from high mortality rates, severe morbidity, impaired quality of life, and frequent hospitalizations and readmissions. The burden of ESRD falls heavily on disadvantaged communities, with higher incidence rates and lower access to nephrology care among racial/ethnic minority populations and those living in high-poverty neighborhoods. Changes in coverage and payment financing policies in the Medicare program have had substantial consequences for access to care and health equity in the ESRD population. For instance, Medicare's decision in 1973 to extend coverage to Americans with irreversible kidney failure led to marked reductions in deaths due to kidney disease and decreased racial disparities in access to dialysis. Effective January 1, 2021, Medicare will open up enrollment of ESRD patients in private Medicare Advantage (MA) plans. Historically, persons with ESRD have been ineligible to join MA plans except under limited exceptions. Eighty-three thousand persons with ESRD (14% of Medicare's ESRD population) are projected to join an MA plan within two years. Unfortunately there is little evidence to guide policymakers about the consequences of managed care for persons with ESRD, variations across plans, and the implications for disparities in kidney health. More broadly, MA enrollment has more than quadrupled over the past 15 years, yet fundamental questions about the value of managed care for persons for serious health conditions remain answered. Our long-term objective is to understand the effects of payment and financing changes on the quality, equity, and outcomes of care for persons with ESRD. This mixed-methods study, the next step in our agenda, will investigate the impact of the Medicare program's expansion of MA enrollment to the ESRD population on dialysis care, hospitalizations and mortality. Our specific aims are: 1. Examine MA plans' approaches to managing care for persons with ESRD by conducting qualitative interviews with representatives from MA plans, dialysis organizations, and dialysis facility staff in geographically diverse markets. 2. Estimate the impact of expanding MA coverage to patients with ESRD on mode of kidney replacement therapy, hospitalizations and mortality. 3. Identify variations in the impact of Medicare Advantage on ESRD outcomes by patient and plan characteristics. The project is innovative because we leverage an unprecedented policy experiment in the Medicare program and the availability of plans across counties to derive causal estimates of the impact of managed care for dialysis patients. This project will have a positive impact by producing timely evidence about the role of MA plans in delivering care for persons with ESRD, a population with complex health needs and social risk factors. We address survival, hospitalizations, and the use of home dialysis, outcomes that have been prioritized by the nephrology community, the Medicare program, and the 2019 Executive Order on Advancing American Kidney Health.