Does Managed Care Improve End-of-Life Care for Medicare Beneficiaries?

管理式医疗是否能改善医疗保险受益人的临终护理？

• 批准号: 10515439
• 负责人: Lauren Hersch Nicholas
• 金额: $ 43.68万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10515439
• 关键词: Does; Managed; Care; Improve; End

PROJECT SUMMARY Numerous studies and a recent Institute of Medicine report have raised concerns about the quality of end-of- life (EOL) care provided to older adults in the United States. Many Medicare beneficiaries receive burdensome treatments (e.g. feeding tube placement, dialysis, and intensive care unit stays) that do not extend their life, die in a hospital, and experience transitions from one setting of care to another late in life. These treatments come at significant financial and emotional cost to the Medicare program, individual beneficiaries and their families, and are associated with the financial incentives and fragmented delivery system embedded in Fee-for-Service (FFS) Medicare. Despite repeated calls to improve patient experiences at the end-of-life (EOL), especially for older adults with Alzheimer's Disease and Related Dementias (ADRD) and other life-limiting illness, little research has considered whether managed care could achieve these goals. Medicare Advantage (MA), the voluntary, managed care alternative to FFS now covers 33% of Medicare beneficiaries at time of death. MA plans receive capitated payments for each beneficiary and are shielded from the cost of most care provided to beneficiaries who enroll in hospice care. These incentives may encourage provision of high-quality EOL care for terminally ill patients. While a small number of descriptive studies point to more appropriate EOL care provision with managed care, the literature has not yet accounted for non-random enrollment in MA, studied MA across market conditions, assessed EOL care for patients with life-limiting illness in MA or examined outpatient EOL care in MA. To address this gap, our team of health economists, health services researchers, physicians and nurse practitioners will use econometric methods with Medicare claims data from 2015 – 2018 including newly available Medicare Advantage encounter data to assess whether and how managed care enrollment affects care for patients with life-limiting illnesses (ADRD, metastatic cancer and end-stage organ failure). We will 1- test whether MA reduces use of potentially inappropriate care near the end-of-life for these patients; 2- assess whether MA provides better outpatient care near the end-of-life to reduce potentially burdensome transitions; and 3- test whether the effect of MA varies with local practice styles, plan payments, and MA market share. The end-of-life represents the most intensive period of healthcare utilization for many Americans. With one- third of Medicare beneficiaries now receiving coverage through MA, it is critical to understand potential differences in the quality of care provided at this time. Information about differences between managed care and traditional Medicare is essential to understand how financial incentives influence EOL care and to develop incentives that better align with patient preferences.

项目总结 许多研究和最近的一份医学研究所的报告都提出了对终端的质量的担忧 在美国为老年人提供的生活(EOL)护理。许多医疗保险受益人承受着沉重的负担 没有延长生命的治疗(如放置喂养管、透析和重症监护病房)会导致死亡 在医院里，在晚年经历从一种护理环境到另一种护理环境的过渡。这些治疗来了 这给医疗保险计划、个人受益人及其家庭带来了巨大的经济和情感代价， 并与嵌入在按服务收费中的财务激励和分散的交付系统相关联 (FFS)联邦医疗保险。尽管一再呼吁改善临终病人的体验，尤其是 患有阿尔茨海默病和相关痴呆症(ADRD)和其他限制生命的疾病的老年人很少 研究已经考虑了管理型医疗能否实现这些目标。 联邦医疗保险优势(MA)是FFS的自愿管理型医疗替代方案，目前覆盖了33%的联邦医疗保险 死亡时的受益人。MA计划接受每个受益人的上缴付款，并受到保护 从为参加临终关怀的受益人提供的大部分护理费用中扣除。这些激励措施可能 鼓励为绝症患者提供高质量的生命周期护理。虽然有少量描述性的 研究指出，通过管理式护理提供更合适的EOL护理，文献尚未说明 对于MA的非随机登记，研究了跨市场条件的MA，评估了对以下患者的EOL护理 马萨诸塞州限制生命的疾病或马萨诸塞州接受检查的门诊患者的EOL护理。 为了解决这一差距，我们的健康经济学家、卫生服务研究人员、医生和护士团队 从业者将使用计量经济学方法处理2015-2018年的联邦医疗保险索赔数据，包括新的 可用的Medicare Advantage遇到数据，以评估管理型医疗登记是否以及如何影响 照顾患有限制生命的疾病(ADRD、转移性癌症和终末期器官衰竭)的患者。我们将1- 测试MA是否减少了这些患者在临终时使用潜在的不适当护理；2-评估 MA是否在临终前提供更好的门诊护理，以减少潜在的负担过渡； 3-检验并购效果是否因当地执业方式、计划支付、并购市场份额不同而不同。 对许多美国人来说，生命的终结代表着医疗保健利用最密集的时期。只有一个- 三分之一的联邦医疗保险受益人现在通过MA获得保险，了解潜在的可能性至关重要 目前提供的护理质量不同。关于管理型医疗保健之间的区别的信息 而传统的医疗保险对于理解财务激励如何影响EOL护理和发展至关重要 更符合患者喜好的激励措施。