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

描述(由申请人提供)：在美国，大约900万符合双重资格的受益人的医疗支出在2010年达到了25万亿美元。然而，目前针对DUALS的财务计划创造了在医疗保险和医疗补助之间转移成本的激励措施，往往会阻碍提高医疗质量的努力，并可能限制这一弱势群体的获得。这项拟议研究的主要目的是比较在综合管理保健系统下提供的医疗服务的使用情况，并将双重符合条件的受益人的结果与参与传统收费服务计划的对照组进行关联。我们将通过评估MassHealth High Care Options(SCO)来检验这一点，SCO是一项整合的Medicare和Medicaid管理式护理计划，为马萨诸塞州的双重符合条件的受益人提供这两项计划提供的全方位服务。具体目标是：目标1：评估参加老年护理方案对医疗服务利用的影响，并将住院、门诊和急性后护理措施与联邦医疗保险FFS中的双重护理措施进行比较。目的2：确定参加老年护理方案是否与较低的死亡率和减少30天的再住院有关。这项拟议的研究将考察相对较长的项目观察期(2001-2008年)和缓解选择偏差的严格计量经济学工具的影响。作为一项确定战略，将使用多种计量方法，包括差异法(DDD)。横截面回归和简单的差异法使估计容易受到选择偏差的影响，这是因为比较了两个系统不同的群体。DDD模式允许通过纳入不应受上海合作组织实施影响的额外对照组(非双重医疗保险FFS受益人)来评估治疗效果。DDD规范将控制与SCO可用性无关的跨县双人健康状况变化引起的混淆。鉴于目前的经济环境和日益增长的人口所需的护理的复杂性，拟议的分析将提供证据，证明为双重资格的人更好地协调医疗补助和医疗保险福利相关的潜在收益。这项研究将解决政策制定者非常及时和重要的关切问题。这些结果将提供深入的见解，从而为符合双重资格的受益人更有效地提供更高质量的护理，提供广泛的服务。 与公共卫生相关：双重资格的受益人，即那些同时有资格享受联邦医疗保险和医疗补助的人，与其他联邦医疗保险参与者相比，通常病情更重，财务资源更少。他们更需要全面的卫生服务，但经常遇到护理缺乏连续性、医疗保险和医疗补助之间的行政协调不足、对所需护理没有明确的问责以及服务之间缺乏平稳过渡的问题。该项目的结果将展示通过综合管理保健计划协调联邦医疗保险和医疗补助福利的影响，以促进更高质量的保健，同时更有效地为这一弱势群体提供卫生服务。

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.