Emerging Role of Medicare Advantage in Nursing Home Care

医疗保险优势在疗养院护理中的新兴作用

• 批准号: 8673221
• 负责人: Vincent Mor
• 金额: $ 44.99万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8673221
• 关键词: Acute; Affect; Caring; Characteristics; Chronically Ill; Clinical Data; Complex; Cost Savings; Data; Data Reporting; Data Set; Decubitus ulcer; Discipline of Nursing; Enrollment; Evaluation; Fee-for-Service Plans; Goals; Growth; Healthcare; Home Nursing Care; Hospitalization; ImProv; Incidence; Individual; Investigation; Knowledge; Link; Long-Term Care; Managed Care; Marketing; Medical; Medicare; Modernization; Morbidity - disease rate; Nurse Practitioners; Nursing Homes; Outcome; Patients; Policies; Population; Probability; Process; Provider; Publishing; Records; Research; Risk; Role; Services; Time; beneficiary; capitate bone; dual eligible; experience; federal policy; improved; member; mortality; nursing home length of stay; payment; programs; public health relevance; restraint

DESCRIPTION (provided by applicant): For over 25 years, Medicare policy has promoted beneficiaries' enrollment in private, risk-bearing plans, currently known as Medicare Advantage (MA) plans. The 2006 Medicare Modernization Act (MMA) increased MA payments and compensated plans for serving more medically complex and frail beneficiaries, stimulating a doubling of the MA population over the past 8 years. This explosive growth in MA enrollment has also occurred among nursing home residents; however, we know virtually nothing about the quality and outcomes of care among nursing home residents in private, managed care plans. This lack of knowledge compromises our ability to understand the implications of expansions of special needs and dual eligible MA plans included in the Affordable Care Act (ACA). Because the Medicare program spends $115 billion in annual capitated payments to MA plans, understanding their emerging role in caring for frail, chronically ill beneficiaries is critical to inform optimal federal policy. Between 2000 and 2010 the prevalent population of MA plan members in nursing homes increased from about 16,000 to 80,000 (about 8% of all long stay residents). Half of these individuals reside in only 500 nursing facilities, each with more than 75 MA plan members. United Healthcare's "Evercare" program, which provides integrated medical care and care management services to MA plan beneficiaries residing in nursing homes, was associated with lower mortality, fewer preventable hospitalizations, and cost- savings of approximately $100,000 per year per nurse practitioner. Of note, Evercare was initiated before the MMA and the subsequent growth of MA plans' use of nursing homes for post-acute and long term care patients. The long-term objective of this research is to inform policy efforts to improv the quality and outcomes of care for vulnerable nursing home residents. The objective of this application, which is the next step in our long-range goal, is to examine the impact of Medicare Advantage plans on the care of nursing home residents, both among residents enrolled in these plans as well as on non-MA residents via "spill-over" effects. The rationale that underlies this investigation is that MA plans have assumed a rapidly growing role in the care of nursing home residents with little knowledge about how managed care may impact this frail, chronically-ill population. Our central hypothesis, which is informed by the results of the Evercare evaluation and the paucity of other studies, is that integrated medical cares in the nursing home setting, particularly in facilities where MA plan residents are concentrated, positively affect patient outcomes. We propose to undertake a comprehensive examination of the growth of these plans and their impact on nursing home care using 15 years (2000 through 2014) of data on MA plans' use of nursing facilities that integrates Medicare enrollment records, HEDIS data reported to CMS, and the mandatory nursing home resident assessment minimum data set (MDS).

描述（由申请人提供）：25年来，医疗保险政策促进了受益人参加私人风险承担计划，目前称为医疗保险优势（MA）计划。2006年的《医疗保险现代化法案》（MMA）增加了MA支付，并为医疗上更复杂和虚弱的受益人提供了补偿计划，刺激了MA人口在过去8年中翻了一番。MA入学率的爆炸性增长也发生在养老院居民中;然而，我们对私人管理式护理计划中养老院居民的护理质量和结果几乎一无所知。这种知识的缺乏损害了我们理解《平价医疗法案》（ACA）中特殊需求和双重合格MA计划扩展的影响的能力。由于医疗保险计划每年向MA计划支付1150亿美元的资本金，因此了解MA计划在照顾体弱、慢性病受益人方面的新兴作用至关重要， 告知最佳联邦政策。 2000年至2010年期间，养老院的MA计划成员的普遍人口从约16，000人增加到80，000人（约占所有长期居住居民的8%）。这些人中有一半居住在仅有的500个护理设施中，每个设施超过75个 MA计划成员。United Healthcare的“Evercare”计划为居住在疗养院的MA计划受益人提供综合医疗护理和护理管理服务，该计划与死亡率降低、可预防的住院治疗减少以及每位执业护士每年约100，000美元的成本节约相关。值得注意的是，Evercare是在MMA之前启动的，随后MA计划将疗养院用于急性期后和长期护理患者。 这项研究的长期目标是为改善弱势养老院居民护理质量和结果的政策努力提供信息。这个应用程序的目的，这是我们的长期目标的下一步，是检查医疗保险优势计划对护理养老院居民的影响，无论是在这些计划中登记的居民，以及通过“溢出”效应对非MA居民。这项调查的基本原理是，MA计划在护理养老院居民方面发挥了迅速增长的作用，但对管理式护理如何影响这一虚弱的慢性病人群知之甚少。我们的中心假设，这是由Evercare评估的结果和其他研究的缺乏，是综合医疗护理在疗养院设置，特别是在设施，MA计划居民集中，积极影响患者的结果。我们建议对这些计划的增长及其对疗养院护理的影响进行全面检查，使用15年（2000年至2014年）的数据，这些数据是关于MA计划使用护理设施的数据，这些数据集成了医疗保险登记记录，向CMS报告的HEDIS数据，以及强制性疗养院居民评估最低数据集（MDS）。