Improving Medicare in an Era of Change: Natural experiments to understand protective effects of Medicaid and Medicare policy during the COVID-19 pandemic for populations with a high rates of dementia

项目概要/摘要 成功地整合医疗融资和服务仍然是Medicare计划的主要目标 经过多年的努力，包括最近一段前所未有的实验，所得 医疗保险的变化为了解支付系统如何影响患者护理创造了机会， 成果。医疗保险优势（MA）计划是医疗保险整合融资的最重要尝试 和关怀.目前，36%的受益人参加了可以影响患者护理的资本私人计划 通过多种机制，包括选择性合同，福利设计和护理， 管理鉴于大多数受益人仍然在传统医疗保险（TM），医疗保险已 努力将融资和护理纳入该计划，包括替代支付 模型（APM），其中医疗保险风险合同与供应商直接。关于MA的优点的证据是 主要是观察性的，对杀伤人员地雷的相对性能知之甚少。此外， 为病人提供的综合筹资和服务仍然不清楚，而且研究不足。直到最近，关于MA的数据 项目不足以支持对护理模式差异的详细经验探索， 潜在的驱动机制。州医疗补助计划中有很多潜在的教训， 使用比MA计划更窄的提供者网络，并越来越多地将护理管理委托给私人 计划，但在医疗补助和医疗保险采取的方法对病人护理的相对影响还没有被 量化。在各种一体化计划中，人们认识到，一种尺寸并不适合所有人;付款 是前瞻性的，或包含前瞻性的元素，使计划和提供者在以下方面有更大的灵活性： 选择护理投入，以支持患者的健康和福祉。但对于患有特殊疾病的患者来说， 需求知之甚少。在支付系统设计和性能监控方面仍然存在许多挑战， 特别是风险调整方法。因此，随着医疗保险的创新和发展，需要进行合理的分析 为了解支付系统如何影响患者提供证据基础。这个项目计划， “在变革时代改善医疗保险”，重点是改变医疗保险计划的后果， 患者护理和结果。它旨在为设计卫生领域的支付系统提供基本见解 在乎我们的研究议程包括四个关键领域：1）MA和TM的比较性能， 每一种的变体; 2）MA计划采用的策略; 3）从州医疗补助计划中学习;以及4） 老年痴呆症患者的医疗保险经验及其对支付系统改进的影响， 有特殊需要的病人。我们的提案通过利用新的数据，建立在我们当前的计划项目基础上 来源和经验方法：检查以前无法回答的问题;支持严格的系统 比较;并通过探索付款和交付的变化来确定潜在的改进方向 医疗保险和医疗补助计划日益多样化。

PROJECT SUMMARY/ABSTRACT Successfully integrating the financing and delivery of care remains a primary goal of the Medicare program after years of expanding efforts, including a recent period of unprecedented experimentation. The resulting changes in Medicare have created opportunities to understand how payment systems affect patient care and outcomes. The Medicare Advantage (MA) program is Medicare's most significant attempt to integrate financing and care. Currently 36% of beneficiaries are enrolled in capitated private plans that can influence patient care and outcomes through multiple mechanisms, including selective contracting, benefit design, and care management. Given that the majority of beneficiaries remain in Traditional Medicare (TM), Medicare has implemented efforts to integrate financing and care in that program as well, including alternative payment models (APMs) in which Medicare risk-contracts with providers directly. The evidence on the merits of MA is largely observational, and little is known about the relative performance of APMs. Moreover, the implications of integrated financing and delivery for patients remain unclear and understudied. Until recently, data on the MA program were insufficient to support detailed empirical exploration of differences in care patterns and the potential mechanisms driving them. Potential lessons abound from state Medicaid programs, which typically use narrower provider networks than MA plans and have increasingly delegated care management to private plans, but the relative impact on patient care of approaches taken in Medicaid and Medicare have not been quantified. There is recognition across the various integration initiatives that one size does not fit all; payments that are prospective, or incorporate prospective elements, give plans and providers greater flexibility in selecting inputs of care to support patients' health and well-being. But the implications for patients with special needs are poorly understood. Many challenges remain in payment system design and performance monitoring, particularly in methods of risk adjustment. Thus, as Medicare innovates and evolves, sound analysis is needed to generate an evidence base for understanding how payment systems affect patients. This Program Project, “Improving Medicare in an Era of Change,” focuses on the consequences of a changing Medicare program for patient care and outcomes. It intends to supply foundational insights for designing payment systems in health care. Our research agenda encompasses four key areas: 1) comparative performance of MA and TM and variants of each; 2) strategies employed by MA plans; 3) learning from state Medicaid programs; and 4) experiences of Medicare patients with dementia and their implications for payment system refinements for patients with special needs. Our proposal builds on our current Program Project by leveraging new data sources and empirical approaches to: examine previously unanswerable questions; support rigorous system comparisons; and identify potential directions for improvement by exploring variation in payment and delivery system features in the increasingly heterogeneous Medicare and Medicaid programs.