The Impact of Coordinating Medicare and Medicaid benefits for the dually-eligible

协调医疗保险和医疗补助福利对双重资格的影响

• 批准号: 8183113
• 负责人: Hye-Young Jung
• 金额: $ 4.28万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8183113
• 关键词: Impact; Coordinating; Medicare; Medicaid; benefits

DESCRIPTION (provided by applicant): Health expenditures for the roughly 9 million dually-eligible beneficiaries in the U.S. are now reaching a quarter of a trillion dollars in 2010. However, the current financial scheme for duals creates incentives to shift cost between Medicare and Medicaid, often hindering efforts to improve quality of care and potentially limiting access for this vulnerable sub population. The main purpose of this proposed study is to compare the use of medical services provided under an integrated managed care system and relate outcomes for dually-eligible beneficiaries with the controls who participate in traditional fee-for-service programs. We will examine this by evaluating MassHealth Senior Care Options (SCO), an integrated Medicare and Medicaid managed care program that offers the full collection of services provided by both programs for dual-eligible beneficiaries in Massachusetts. The specific aims are: Aim 1: To estimate the effects of participation in Senior Care Options on medical services utilization, with measures of inpatient, ambulatory and post-acute care compared to duals in Medicare FFS. Aim 2: To determine whether participation in Senior Care Options is associated with lower mortality and reduced 30 day re-hospitalization. The proposed study will examine the effects with a relatively long period of program observation (2001-2008) and rigorous econometric tools that mitigate selection bias. As an identification strategy, multiple econometric methods, including difference-in-difference-in-differences (DDD), will be utilized. Cross-sectional regression and simple difference-in-differences approaches leave estimates vulnerable to selection bias due to comparing two systemically different groups. A DDD model allows the effect of treatment to be assessed with the inclusion of an additional comparison group (non-dual Medicare FFS beneficiaries) that should not be affected by the implementation of SCO. The DDD specification will control for confounding arising from changes in health status of duals across counties which have nothing to do with SCO availability. Given the current economic environment and the complexity of care this growing population requires, the proposed analysis will provide evidence of the potential gains associated with better coordination of Medicaid and Medicare benefits for the dually-eligible. The study will address a very timely and important issue of concern for policymakers. The results will provide insights leading to higher quality of care provided more efficiently for dually-eligible beneficiaries for a wide range of services. PUBLIC HEALTH RELEVANCE: Dually-eligible beneficiaries, those who qualify for both Medicare and Medicaid, are generally sicker with fewer financial resources compared to other Medicare enrollees. They have a greater need for comprehensive health services, but often encounter a lack of continuity of care, inadequate administrative coordination between Medicare and Medicaid, no clear accountability for needed care, and a lack of smooth transitions between services. The findings from this project will demonstrate the influence of coordinating Medicare and Medicaid benefits through an integrated managed care program to promote higher quality of care while providing health services more efficiently for this vulnerable population.

描述（由申请人提供）：2010年，美国大约900万双重资格受益人的医疗支出达到了2.5万亿美元。然而，目前的医疗保险财政计划鼓励在医疗保险和医疗补助之间转移成本，这往往阻碍了提高护理质量的努力，并可能限制了这一弱势群体的获得。这项拟议研究的主要目的是比较使用的医疗服务下提供的综合管理医疗系统和相关成果的双重资格的受益人与控制谁参加传统的收费服务计划。我们将通过评估MassHealth高级护理选项（SCO）来检查这一点，这是一个综合的医疗保险和医疗补助管理式护理计划，为马萨诸塞州的双重合格受益人提供两个计划提供的全部服务。具体目标是：目标1：评估参与老年护理选项对医疗服务利用的影响，与Medicare FFS中的老年护理相比，采用住院、门诊和急性后护理措施。目的2：确定参与高级护理选项是否与较低的死亡率和减少30天再住院有关。拟议的研究将检查一个相对较长的计划观察期（2001-2008年）和严格的计量经济学工具，减轻选择偏差的影响。作为一种确定战略，将使用多种计量经济学方法，包括差异中差异（DDD）。横截面回归和简单的差异中的差异方法使估计容易受到选择偏差，因为比较两个系统不同的群体。DDD模型允许评估治疗效果，包括一个额外的比较组（非双重医疗保险FFS受益人），不应受到SCO实施的影响。DDD规范将控制因县间受试者健康状态变化而产生的混淆，这些变化与SCO可用性无关。鉴于目前的经济环境和护理的复杂性，这一不断增长的人口需要，拟议的分析将提供证据的潜在收益与更好地协调医疗补助和医疗保险福利的双重资格。这项研究将解决决策者非常及时和重要的关切问题。结果将提供见解，导致更高质量的护理提供更有效地为双重资格的受益人提供广泛的服务。 公共卫生相关性：双重资格的受益人，那些谁都有资格获得医疗保险和医疗补助，一般是生病较少的财政资源相比，其他医疗保险登记。他们更需要全面的卫生服务，但往往遇到缺乏连续性的照顾，医疗保险和医疗补助之间的行政协调不足，没有明确的责任，所需的照顾，并缺乏服务之间的平稳过渡。该项目的研究结果将证明通过综合管理的医疗保健计划协调医疗保险和医疗补助福利的影响，以促进更高质量的护理，同时更有效地为这一弱势群体提供医疗服务。