Comparing Dialysis Provision and Outcomes Between Medicare Advantage and Fee-for-Service Medicare

比较 Medicare Advantage 和按服务收费 Medicare 之间的透析服务和结果

• 批准号: 10551836
• 负责人: Eugene Lin
• 金额: $ 12.38万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10551836
• 关键词: Affordable Care Act; Area; Caring; Chronic Disease; Contracts; Cost Savings; Data; Data Reporting; Data Set; Data Sources; Dialysis procedure; Disease Outcome; Eligibility Determination; End stage renal failure; Enrollment; Fee-for-Service Plans; Future; Healthcare; Heterogeneity; Hospitalization; Incentives; Individual; Information Systems; Insurance; Insurance Carriers; Kidney; Link; Marketing; Mediation; Medicaid; Medicare; Morbidity - disease rate; Outcome; Outpatients; Ownership; Patients; Penetration; Policies; Population; Price; Privatization; Provider; Qualifying; Registries; Reporting; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resistance; Schedule; Services; Uninsured; United States; Variant; Work; care coordination; comorbidity; cost; experience; health care service utilization; hospitalization rates; improved; improved outcome; innovation; mortality; novel; payment; provider networks; statistics; uptake

7. ABSTRACT Most patients requiring dialysis for end-stage kidney disease (ESKD) obtain Medicare, with the majority enrolling in fee-for-service (FFS or traditional) Medicare. Medicare Advantage (MA), when private insurers coordinate Medicare benefits, is an alternative to FFS Medicare. However, prior to 2021, patients with ESKD could only enroll prior to developing ESKD. Consequently, only 22% of Medicare patients with ESKD have an MA plan, compared to 36% of Medicare patients without ESKD. The 21st Century Cures Act opened MA to all patients with ESKD in 2021, and experts anticipate a large influx of enrollment into MA. Proponents of MA argue that it results in better care-coordination of chronic diseases, leading to improved outcomes and reduced costs in the non-ESKD population. It is unclear whether these findings extend to ESKD, and research on MA ESKD outcomes are conspicuously sparse, despite its imminent importance. A key explanation is a lack of available research data. The United States Renal Data System (USRDS), the dataset used for most dialysis research, almost exclusively contains data on FFS Medicare. Additionally, because MA plans and dialysis providers negotiate proprietary contracts for dialysis payment, MA dialysis reimbursements have substantial variation, making comparisons across MA plans and providers difficult. Thus, researchers have focused primarily on FFS Medicare. We will use a novel linkage between MA claims data and the USRDS dataset to investigate outcomes in the MA dialysis population. In addition to being one of the first research projects to broadly study dialysis in MA, our work will develop a research infrastructure that will make future research on MA and ESKD more accessible. A key innovation is identifying a comparable unit of dialysis treatment (and all related services) across MA plans and providers, and with FFS Medicare. In Aim 1, we will investigate whether patients with MA accrue the benefits of improved care-coordination seen in non-dialysis populations with MA. We will study whether MA results in improved outcomes at the start of dialysis (e.g., starting dialysis as outpatients) and whether prevalent patients with MA and ESKD experience fewer hospitalizations or have lower mortality. As a potential mechanism for improved care-coordination, we will explore whether MA patients are more likely to receive extra outpatient dialysis sessions over the conventional thrice weekly dialysis schedule. Aim 2 will assess heterogeneity in the MA market. We will study how market concentration at the dialysis facility, the dialysis chain, and the MA plan levels modify our findings in Aim 1. For instance, dialysis providers with few regional competitors may have more market power and, consequently, might be resistant to care-coordination and cost-saving initiatives by MA plans. The proposed work will form the impetus for a larger research effort, including an R01 application, aimed at studying the impact of the 21st Century Cures Act and of expanding MA eligibility for the dialysis population in the United States.

7. 摘要 大多数因终末期肾病 (ESKD) 需要透析的患者都获得医疗保险，其中大多数 加入按服务收费（FFS 或传统）医疗保险。 Medicare Advantage (MA)，当私人保险公司 协调 Medicare 福利，是 FFS Medicare 的替代方案。然而，在 2021 年之前，ESKD 患者 只能在开发 ESKD 之前注册。因此，只有 22% 的 Medicare 患有 ESKD 的患者有 MA 计划，相比之下 36% 的 Medicare 患者没有 ESKD。 《21 世纪治愈法案》向所有人开放了 MA 2021 年，ESKD 患者将大量涌入 MA，专家预计将有大量患者涌入 MA。 MA的支持者 认为它可以更好地协调慢性病的护理，从而改善结果并减少 非 ESKD 人群的成本。目前尚不清楚这些发现是否适用于 ESKD 以及 MA 的研究 尽管 ESKD 具有迫在眉睫的重要性，但其结果却明显稀疏。一个关键的解释是缺乏 可用的研究数据。美国肾脏数据系统 (USRDS)，用于大多数透析的数据集 研究几乎完全包含 FFS 医疗保险的数据。此外，由于 MA 计划和透析 医疗服务提供者就透析付款的专有合同进行谈判，MA 透析报销具有可观的 差异，使得 MA 计划和提供商之间的比较变得困难。因此，研究人员将注意力集中在 主要是 FFS 医疗保险。我们将使用 MA 索赔数据和 USRDS 数据集之间的新颖联系来 调查 MA 透析人群的结果。除了是首批研究项目之一 在马萨诸塞州广泛研究透析，我们的工作将开发一个研究基础设施，使未来的研究 MA 和 ESKD 更容易获得。一项关键的创新是确定透析治疗的可比单位（以及所有 相关服务）跨 MA 计划和提供商以及 FFS Medicare。在目标 1 中，我们将调查是否 MA 患者可以从非透析 MA 患者中改善护理协调中获益。 我们将研究 MA 是否会在透析开始时改善结果（例如，开始透析时 门诊患者）以及 MA 和 ESKD 的患病率患者住院次数是否较少或是否有 死亡率较低。作为改善护理协调的潜在机制，我们将探讨 MA 患者是否 与传统的每周三次透析相比，更有可能接受额外的门诊透析治疗 日程。目标 2 将评估 MA 市场的异质性。我们将研究市场集中度如何 透析设施、透析链和 MA 计划级别修改了我们在目标 1 中的发现。例如，透析 区域竞争对手很少的供应商可能拥有更大的市场力量，因此可能会抵制 MA 计划的护理协调和成本节约举措。拟议的工作将形成更大的推动力 研究工作，包括 R01 申请，旨在研究 21 世纪治愈法案和 扩大美国透析人群的 MA 资格。