Cancer detection and care for dually-enrolled beneficiaries in the Medicare Shared Savings Program

项目概要/摘要 双重参加医疗保险和医疗补助（“Medicare”）的个人是社会和临床弱势群体 他们在两个项目支付的医疗费用中所占的比例不成比例。双胞胎有一个 与仅医疗保险受益人相比，疾病负担更高，超过20%的人患有 多种慢性疾病双胞胎也有更糟糕的癌症结果。他们不太可能得到 推荐的筛查，不太可能在癌症诊断后接受明确的治疗， 癌症特异性死亡风险更高。复杂的社会和医疗保健需求对儿童提出了挑战， 为这些患者提供高质量的癌症治疗。 责任医疗组织（ACO）致力于为患者提供协调一致的高质量护理， 包含付款人的费用。作为Medicare的主要ACO模式，Medicare共享储蓄计划 （MSSP）在提高护理质量，为每个受益人节省费用以及照顾 临床脆弱的患者。MSSP是否提高了整个癌症连续体的护理质量， 相对而言，它仍然是未知的。 拟议的研究调查了MSSP ACO模型在多大程度上提高了临床癌症护理的质量。 复杂脆弱的患者群体研究将比较MSSP归因于癌症的结果， 没有得到MSSP ACO护理的患者。目的1将评估MSSP ACOs对乳腺癌的影响 以及使用准实验差异分析的结肠直肠癌筛查。目标2将 采用至事件发生时间生存分析，比较乳腺癌或结直肠癌术后至治疗开始的时间。 癌症诊断使用广义估计方程，目标3将评估总体医疗保险 乳腺癌和结直肠癌患者第一年的癌症治疗费用。总的来说， 这项拟议研究的结果将告知政策制定者和提供者， 为双入组的乳腺癌和结直肠癌患者提供更好的筛查和治疗护理质量 受益人。

PROJECT SUMMARY/ABSTRACT Individuals dually enrolled in Medicare and Medicaid (“duals”) are a socially and clinically vulnerable population who account for a disproportionate amount of healthcare expenditures paid by both programs. Duals have a higher burden of disease compared to Medicare only beneficiaries, with more than 20% of individuals having multiple chronic conditions. Duals also have worse cancer outcomes. They are less likely to receive recommended screening, are less likely to receive definitive treatment after a cancer diagnosis, and have a higher risk of cancer-specific mortality. The complex social and healthcare needs of duals present a challenge in effectively delivering high quality cancer care to these patients. Accountable care organizations (ACOs) strive to provide coordinated, high-quality care to patients while containing costs for payers. As Medicare’s predominant ACO model, the Medicare Shared Savings Program (MSSP) has shown promise in improving quality of care, generating savings per beneficiary, and caring for clinically vulnerable patients. Whether the MSSP increases the quality of care across the cancer continuum for duals remains relatively unknown. The proposed study investigates how much the MSSP ACO model improves quality of cancer care for a clinically complex, vulnerable patient population. Studies will compare cancer outcomes for MSSP-attributed duals to duals who did not receive care from the MSSP ACO. Aim 1 will estimate the effect of MSSP ACOs on breast and colorectal cancer screening of duals using a quasi-experimental difference-in-difference analysis. Aim 2 will employ a time-to-event survival analysis to compare the time to treatment initiation after a breast or colorectal cancer diagnosis. Using generalized estimating equations, Aim 3 will assess differences in total Medicare spending in the first year of cancer treatment for duals with breast and colorectal cancer. Taken together, the results of this proposed study will inform policymakers and providers on whether value-based care reforms deliver better quality of care in screening and treatment of breast and colorectal cancer for dually enrolled beneficiaries.