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Private Medicare Plans and Health Outcomes for Older Adults

老年人的私人医疗保险计划和健康结果

基本信息

批准号：
10283190
负责人：
Vilsa Eliana Curto
金额：
$ 12.14万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10283190
关键词：
Address American Area Award Cardiovascular Diseases Caring Characteristics Chronic Clinical Clinical Management Comprehensive Health Care Cost Control Cost Savings Country County Data Databases Diabetes Mellitus Economic Policy Elderly Enrollment Face Fee-for-Service Plans Fee-for-Service Reimbursements Goals Health Health Care Costs Health Insurance Health Personnel Health Policy Health Status Healthcare Systems Institution Insurance Insurance Benefits Insurance Carriers K-Series Research Career Programs Knowledge Learning Life Managed Care Programs Massachusetts Measurement Measures Medicare Mentorship Methods Modeling Modernization Outcome Patient Care Patient-Focused Outcomes Patients Performance Preventive care Preventive service Privatization Provider Public Policy Quality of Care Quasi-experiment Regulation Research Research Personnel Research Support Risk Risk Adjustment Services Statistical Methods System Training United States Variant Work adverse outcome base care coordination care outcomes career financial incentive health care quality health economics health plan high risk improved improved outcome member mortality patient subsets payment predictive modeling programs provider networks public health insurance readmission rates skills

项目摘要

Although enrollment in private Medicare plans has risen from 12.8% in 2004 to 37.5% in 2019, the health consequences of large numbers of older Americans enrolling in these plans are not clear. This is of particular concern for high-risk patients, people with selected chronic conditions that place them at higher risk of adverse outcomes. Private Medicare plans are typically managed care plans that receive a capitated payment for each plan enrollee and therefore face financial incentives to control costs. Although high-risk patients could potentially benefit if some private Medicare plans are able to improve health outcomes through care coordination or by steering patients to high-quality health care providers, they could also be adversely impacted if some private Medicare plans achieve cost savings by reducing provision of necessary or preventive care. This Career Development Award proposal, “Private Medicare Plans and Health Outcomes for Older Adults,” focuses on leveraging new data—from private Medicare encounter claims, a state all-payer claims database, and the private Medicare risk adjustment system—in order to better understand how private Medicare plans impact health outcomes for older adults, particularly among high-risk patients. This work will focus on evaluating the performance of specific private Medicare plans—as opposed to evaluating private Medicare plans as a whole—something made possible by the recent availability of comprehensive health care claims data from private Medicare plans. Examining plan-specific effects will allow for a more complete understanding of whether there are specialized private Medicare plans that can improve health outcomes for high-risk patients. The research aims encompass three areas: 1) estimating plan-specific effects of private Medicare plans on quality of care and patient outcomes, 2) evaluating the performance of private Medicare plans that specialize in improving health outcomes for high-risk patients, and 3) using prediction methods to quantify the potential for favorable selection by private Medicare plans. This work will make use of quasi- experimental methods to estimate whether enrollment in specific private Medicare plans is associated with better health outcomes; for example, by studying patients who transition from an employer- sponsored plan to a private Medicare plan, or patients who switch from traditional Medicare to a private Medicare plan. This award will also support additional training toward three career goals that support the research aims: 1) developing expertise in measurement of health care quality and improvement of patient outcomes, 2) acquiring knowledge of clinical management of high-risk patients, and 3) building skills in statistical methods used for prediction and modeling health outcomes. These goals will be achieved through coursework, mentorship, seminars, and research, among a highly productive group of health economics and health policy scholars at a leading institution.

尽管参加私人医疗保险计划的人数从2004年的12.8%上升到2019年的37.5%，但健康状况