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Optimizing Medicare Part D Plan Choice by Beneficiaries with Schizophrenia

优化精神分裂症受益人的 Medicare D 部分计划选择

基本信息

批准号：
8775263
负责人：
Yuting Zhang
金额：
$ 22.73万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-12-01 至 2016-11-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The Medicare prescription drug benefit (Part D) relies on private market mechanisms to deliver care: a typical beneficiary can choose from between 45 and 57 private stand-alone Part D plans (PDP) in 2009, depending on his/her region of residence. It is known that beneficiaries do not choose plans based on their medication needs; and that the ability to choose plans is poorer among beneficiaries with mental disorders. The purpose of this study is to simulate personalized plan choice based on patient medication needs in schizophrenia and quantify potential improvement in patient drug coverage and potential savings to the government. Part D provides substantial premium and cost-sharing assistance to beneficiaries qualifying for the low-income subsidy (LIS) program. About 93% of PDP enrollees with schizophrenia received the LIS in 2007, whereas 40% of all PDP enrollees did. The majority of LIS enrollees are randomly assigned to PDP plans with premiums at or below the regional average. Random assignment does not assign enrollees to plans based on their medication needs and has caused severe problems including disruptions in plan coverage for 5.9 million between 2007 and 2010; and high beneficiary and government spending for those assigned to plans requiring high copayments. Our study will develop intelligent assignment algorithms based on beneficiaries' medication needs and dynamics of plan features in the Part D market. The algorithms can be easily implemented each year after an initial setup of software without substantial costs. The intelligent assignment method can be used by the government to assign/reassign beneficiaries or provide personalized assistance to help beneficiaries with schizophrenia to choose plans. The intelligent assignment method has the potential to substantially reduce government spending while improving patient outcomes.

医疗保险处方药福利（D部分）依赖于私人市场机制来提供护理：2009年，典型的受益人可以从45至57个私人独立D部分计划（PDP）中选择，具体取决于他/她的居住地区。众所周知，受益人不会根据其药物需求选择计划;患有精神障碍的受益人选择计划的能力较差。本研究的目的是根据精神分裂症患者的药物需求模拟个性化计划选择，并量化患者药物覆盖率的潜在改善和政府的潜在节省。 D部分为符合低收入补贴方案资格的受益人提供大量保险费和费用分摊援助。2007年，约93%的PDP精神分裂症患者接受了LIS，而所有PDP患者中有40%接受了LIS。大多数LIS登记者被随机分配到PDP计划，保费等于或低于区域平均水平。随机分配并没有根据他们的药物需求将注册者分配到计划中，并造成了严重的问题，包括2007年至2010年期间590万计划覆盖范围的中断;以及那些分配到需要高共同负担的计划的高受益人和政府支出。我们的研究将根据受益人的用药需求和Part D市场中计划功能的动态开发智能分配算法。这些算法可以在软件初始设置后每年轻松实现，而无需大量成本。智能分配方法可由政府用于分配/重新分配受益人或提供个性化帮助，以帮助精神分裂症受益人选择计划。智能分配方法有可能大幅减少政府支出，同时改善患者的治疗效果。