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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

基本信息

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
项目类别：
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

项目摘要

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，目前被称为医疗保险优势（MA）计划。2006年《医疗保险现代化法案》（MMA）增加了医疗保险的支付和补偿计划，为更多医疗复杂和虚弱的受益人提供服务，刺激了过去8年医疗保险人口翻了一番。硕士入学人数的爆炸式增长也发生在养老院的居民中；然而，我们对私人管理的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）中扩大特殊需求和双重合格MA计划的影响的能力。由于医疗保险计划每年花费1150亿美元用于养老保险计划，因此了解它们在照顾体弱多病、慢性病受益人方面的新作用至关重要