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）：超过25年，Medicare政策促进了受益人的私人风险计划，目前称为Medicare Advantage（MA）计划。 2006年《 Medicare Modernation Act》（MMA）增加了MA的付款和补偿计划，以提供更复杂和脆弱的受益人，在过去8年中刺激了MA人口的一倍。疗养院居民中也发生了这种爆炸性的爆炸性增长。但是，我们几乎一无所知，对私人托管护理计划中疗养院居民的质量和护理结果一无所知。缺乏知识损害了我们了解特殊需求扩展和双重合格MA计划（ACA）（ACA）中的双重合格MA计划的含义的能力。由于Medicare计划花费1,150亿美元的年度付款给MA计划，因此了解他们在照顾脆弱的新兴角色，因此长期病态的受益人对 告知最佳联邦政策。 在2000年至2010年之间，疗养院中的MA计划成员的普遍人口从约16,000增加到80,000（约占所有长期居民的8％）。这些人中有一半居住在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的医疗和护理管理服务，与较低的死亡率，更少的可预防住院治疗以及每位护士从业者每年约100,000美元的成本销售有关。值得注意的是，Evercare是在MMA之前启动的，随后MA计划使用疗养院来急性和长期护理患者。 这项研究的长期目的是为政策努力提供为改善弱势养老院居民的质量和护理结果的努力。该应用程序的目的是我们远程目标的下一步，是检查Medicare Advantage计划对疗养院居民护理的影响，包括参加这些计划的居民以及通过“溢出”效果对非MA居民的居民。基于此调查的基本原理是，MA计划在养老院居民的护理中迅速提高了作用，对托管护理如何影响这种脆弱的，长期以来的人口。我们的中心假设是由EverCare评估的结果和其他研究缺乏的结果所告知的，是在疗养院环境中的综合医疗护理，尤其是在MA计划居民集中的设施中，对患者的结果产生了积极影响。我们建议使用15年（2000年至2014年）对MA计划的使用数据进行全面检查，并对其对疗养院护理的影响进行全面研究，以整合Medicare入学记录，报告给CMS的HEDIS数据以及强制性护理家庭居住的居民评估最低数据（MDS）。