Health Policy Implication of Dual Enrollment in the VA and Medicare Advantage

描述（由申请人提供）： 对退伍军人医疗保健的预期影响这项研究将提供一个全面的国家评估，评估VA和非VA医疗服务的使用，VA资助的成本，以及双重参加医疗保险优势（MA）计划的所有VA参加者的护理质量。我们的初步调查结果表明，在CY 2009年，所有VA用户中有11%同时参加了MA计划，VA花费了32亿美元（约占其运营预算的10%）用于为这一人群提供医疗服务。因此，在这两个管理式医疗系统中协调融资和服务提供对退伍军人事务部和其他联邦政策制定者至关重要。该项目的目标是为同时在退伍军人事务部和医学部注册的人提供关于资助和提供保健的联邦政策。在美国，符合条件的成年人可以选择同时参加两个不同的管理式医疗系统：由医疗保险和医疗补助服务中心管理的MA计划和由退伍军人健康管理局管理的VA医疗保健系统。虽然退伍军人管理局可以为参加私人健康计划的退伍军人管理局用户提供的护理收取补偿，但联邦法律禁止退伍军人管理局从医疗保险资助的健康计划中收取任何补偿。双重登记可能会产生多余的联邦支付和照顾复杂的慢性疾病登记者的碎片。很少有研究量化了VA和MA双入组的临床和经济后果。项目目标我们的主要目标是：（1）评估同时参加Medicare Advantage计划的VA医疗保健系统用户的医疗保健服务的利用率和VA资助的成本;（2）比较以下三组同时参加VA和MA的退伍军人的糖尿病，心血管和癌症筛查护理的质量：退伍军人谁专门接受护理在VA，退伍军人谁接受护理在VA和MA，和退伍军人谁专门接受护理在MA的退伍军人;（3）了解分散的融资对护理质量的影响在VA和医疗保险优势的双重登记者。我们将合并13个国家VA和医疗保险的临床和行政数据集从2004年到2013年，以获得所有VA注册谁同时参加了医疗保险优势计划的人口。对于这一队列，我们将评估VA和Medicare Advantage中门诊和急性住院治疗的分布，使用平均成本方法的VA资助护理的总成本，以及使用工具变量和倾向评分方法的分散融资对双重登记退伍军人护理质量的影响。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare This study will provide a comprehensive national assessment of the use of VA and non-VA health services, VA-financed costs, and quality of care for all VA enrollees who are dually enrolled in a Medicare Advantage (MA) plan. Our preliminary findings indicate that 11% of all VA users in CY2009 were simultaneously enrolled in an MA plan and that the VA spent $3.2 billion (approximately 10% of its operating budget) on health services for this population. Therefore, the coordination of financing and service delivery across these two managed care systems is of vital interest to VA and other federal policymakers. The goal of this project is to inform federal policy regarding the financing and delivery of health care for persons who are dually enrolled in the VA and MA. Project Background In the United States, eligible adults may choose to enroll simultaneously in two distinct managed care systems: the MA program administered by the Centers for Medicare and Medicaid Services and the VA Healthcare System, administered by the Veterans Health Administration. Although the VA may collect reimbursements for care provided to VA users enrolled in private health plans, federal law prohibits the VA from collecting any reimbursements from Medicare-financed health plans. Dual enrollment may produce redundant federal payments and fragmentation of care for enrollees with complex chronic medical conditions. Few studies have quantified the clinical and economic consequences of dual enrollment in VA and MA. Project Objectives Our primary objectives are: (1) to assess the utilization and VA-financed costs of health care services for VA health care system users who are simultaneously enrolled in a Medicare Advantage plan; (2) to compare the quality of diabetes, cardiovascular, and cancer screening care among the following three groups of veterans who are dually enrolled in VA and MA: veterans who exclusively receive care in the VA, veterans who receive care in both VA and MA, and veterans who exclusively receive care in MA; (3) to understand the effect of fragmented financing on the quality of care among dual enrollees in VA and Medicare Advantage. Project Methods We will merge 13 national VA and Medicare clinical and administrative datasets from 2004 through 2013 to derive the population of all VA enrollees who were simultaneously enrolled in a Medicare Advantage plan. For this cohort, we will assess the distribution of ambulatory and acute inpatient care in the VA and Medicare Advantage, the total costs of VA-financed care using average-cost methods, and the effect of fragmented financing on the quality of care for dually enrolled veterans using both instrumental variable and propensity-score approaches.