Quality and Outcomes under Medicaid Managed Care: Evidence from Random Plan Assignment

医疗补助管理护理的质量和结果：来自随机计划分配的证据

• 批准号: 10380618
• 负责人: Timothy Layton
• 金额: $ 14.7万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10380618
• 关键词: Quality; Outcomes; under; Medicaid; Managed

Project Abstract Dr. Layton is an assistant professor of health care policy in the Department of Health Care Policy at Harvard Medical School. He has a PhD in economics from Boston University and was previously a National Institute of Mental Health Postdoctoral Research Fellow at Harvard Medical School. He has expertise in theoretical and empirical microeconomics, with a specific focus on the application of quasi-experimental methods to questions related to health economics. His specific area of research is the economics of health insurance markets, and his previous work has focused on the Medicare Advantage program and the state and federal Health Insurance Marketplaces. Dr. Layton has a specific interest in vulnerable groups like low-income households, children, and the disabled. This interest has led him to Medicaid, a program that has changed dramatically over the last two decades both in size and structure, with the most significant change arguably being the shift to providing Medicaid benefits via private Medicaid Managed Care (MMC) plans. His primary long-term career goal is to become a national expert in MMC. The purpose of this Mentored Research Scientist Research Career Development Award (K01) is to help him fulfill that goal. Relatively low payment levels in Medicaid have led to concerns about the quality of care provided to individuals enrolled in the program. Because of this, any Medicaid expert must also be a quality expert. The training plan in this proposal focuses on helping Dr. Layton achieve his goal of developing the quality and outcomes measurement skills he needs to contribute meaningfully to this area. The plan includes formal and informal coursework with clinical researchers who are experts in quality measurement, and a one-year “apprenticeship” with experts in this area. Because Medicaid is a program where states have a great deal of flexibility and control leading to wide variation across and substantial complexity within state Medicaid programs, relationships between stakeholders and researchers are critical for producing relevant and accurate scholarship on Medicaid. The second part of the training plan focuses on Dr. Layton's development of relationships with Medicaid stakeholders that will benefit him throughout his career. The research project proposed as part of this award focuses on MMC. In the first part of the project, Dr. Layton will leverage random assignment of Medicaid recipients to Medicaid plans to bring experimental evidence to the question of whether patients receive higher quality care and achieve better health outcomes under public fee-for-service Medicaid or under private MMC plans. In the second part of the project, Dr. Layton will bring quasi-experimental methods to questions about how states should structure their MMC programs. Many states have already decided to go “all-in” on MMC, making questions related to MMC program structure (i.e. plan payment, plan selection, etc.) some of the most relevant in the Medicaid area. After accomplishing the training and research aims in this project, Dr. Layton will be well on his way to becoming and independent investigator and expert in MMC.

项目摘要 雷顿博士是哈佛医学院医疗保健政策系的医疗保健政策助理教授。 他拥有波士顿大学经济学博士学位，曾任国家心理健康研究所博士后 哈佛医学院研究员。他拥有理论和实证微观经济学方面的专业知识，并具有特定的 重点关注准实验方法在卫生经济学相关问题中的应用。他的具体研究领域 是健康保险市场的经济学，他之前的工作重点是医疗保险优势计划和 州和联邦健康保险市场。雷顿博士对低收入等弱势群体特别感兴趣 家庭、儿童和残疾人。这种兴趣使他加入了医疗补助计划，该计划在过去几年里发生了巨大的变化 过去二十年无论是在规模还是结构上，最显着的变化可以说是向提供医疗补助的转变 通过私人医疗补助管理式医疗 (MMC) 计划获得福利。他的首要长期职业目标是成为国家级专家 MMC。导师研究科学家研究职业发展奖（K01）的目的是帮助他实现这一目标 目标。医疗补助支付水平相对较低，引发了人们对向参保个人提供的护理质量的担忧 在节目中。因此，任何医疗补助专家也必须是质量专家。本提案中的培训计划重点 帮助雷顿博士实现他需要贡献的质量和结果衡量技能的目标 对这个领域有意义。该计划包括与临床研究人员合作的正式和非正式课程，这些研究人员是以下领域的专家： 质量测量，以及与该领域专家为期一年的“学徒”。因为医疗补助计划规定 具有很大的灵活性和控制力，导致各州医疗补助范围内存在巨大差异和巨大复杂性 项目、利益相关者和研究人员之间的关系对于产生相关和准确的学术成果至关重要 医疗补助。培训计划的第二部分重点关注雷顿博士与医疗补助计划关系的发展 将使他在整个职业生涯中受益的利益相关者。作为该奖项的一部分提出的研究项目重点关注 MMC。 在该项目的第一部分中，雷顿博士将利用医疗补助计划接受者的随机分配来带来 患者是否接受更高质量的护理并获得更好的健康结果这一问题的实验证据 根据公共按服务付费医疗补助计划或私人 MMC 计划。在该项目的第二部分中，雷顿博士将带来 准实验方法来解决有关国家应如何构建其 MMC 计划的问题。许多州已经 决定“全力以赴”MMC，提出与 MMC 计划结构相关的问题（即计划付款、计划选择等） 一些与医疗补助领域最相关的内容。在完成本项目的培训和研究目标后，雷顿博士 他将很快成为 MMC 领域的独立调查员和专家。