Project 1: Utilization, Quality, Selection and Prices in MA Going Forward

项目 1：MA 未来的利用、质量、选择和价格

• 批准号: 9756139
• 负责人: Bruce E. Landon
• 金额: $ 51.1万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9756139
• 关键词: Address; Affect; Benchmarking; Caring; Categories; Characteristics; Contracts; Cost Sharing; County; Data; Enrollment; Expenditure; Extinction (Psychology); Face; Federal Government; Fee-for-Service Plans; Future; Health; Health Benefit; Health Personnel; Light; Managed Care Programs; Measurement; Measures; Mediation; Medicaid eligibility; Medicare; Methods; Modeling; Monitor; Patients; Performance; Policies; Population; Price; Privatization; Program Efficiency; Provider; Quality of Care; Regulation; Research; Resources; Risk; Risk Adjustment; Role; Service provision; Sorting - Cell Movement; Structure; Surveys; System; Time; Work; base; beneficiary; care systems; design; dual eligible; experience; flexibility; health care delivery; health plan; high reward; innovation; payment; programs; retiree; risk selection; trend; willingness

PROJECT SUMMARY/ABSTRACT Even with the advent of Accountable Care Organizations (ACOs), for the foreseeable future the Medicare Advantage (MA) program is likely to remain numerically the most important alternative to Traditional Medicare (TM). Although MA currently enrolls over a quarter of Medicare beneficiaries, the reimbursement reductions ushered in by the ACA could diminish the array of supplemental benefits offered to MA beneficiaries, increase premium and cost sharing levels, and decrease the willingness of both beneficiaries and plans to participate. Moreover, many of these changes could also affect selection, the management of care, and prices private MA plans negotiate with health care providers with repercussions for the entire delivery system. Given the prominence of MA in the Medicare program, evaluating these critical aspects of MA in light of these policy changes represents an important opportunity for research. In addition, despite substantial new and important contributions by our team to the understanding of current risk adjustment methods in addressing risk selection, their adequacy in the face of the ACA's payment cuts remains an open question. This project continues our study of the provision of services, selection, and the quality of care under MA and how all of those change over time as new policies are implemented. By continuing the complementary stock and flow comparisons of health risks in the MA and TM populations that we have employed using both administrative and survey data, we will clarify how payment changes affect the performance of MA and TM. Furthermore, through the incorporation of data from Truven MarketScan as well as from several additional health plans that serve this market, we will be able to examine for the first time pricing MA plans obtain from providers and examine how those prices change over time and relate to market-level factors such as provider concentration. In short, in our current Program project we have developed methods to address the salient policy issues that MA poses, we have addressed them at a time when reimbursement was becoming more generous and MA was expanding, and now we can apply our methods to a more austere reimbursement policy in which successful ACOs may nonetheless decide to convert to MA plans.

项目总结/摘要 即使随着责任医疗组织（ACO）的出现，在可预见的未来， 优势（MA）计划在数字上可能仍然是传统医疗保险的最重要替代方案 （TM）。尽管MA目前招收了超过四分之一的医疗保险受益人， ACA引入的新规定可能会减少向MA受益人提供的一系列补充福利，增加 保险费和费用分摊水平，降低了受益人和计划的参与意愿。 此外，许多这些变化也可能影响选择，护理管理和价格私人MA 计划与卫生保健提供者进行谈判，对整个提供系统产生影响。鉴于 MA在医疗保险计划中的突出地位，根据这些政策评估MA的这些关键方面 变化是研究的重要机会。此外，尽管新的和重要的 我们的团队在解决风险选择方面对理解当前风险调整方法的贡献， 面对ACA的付款削减，他们是否足够仍然是一个悬而未决的问题。 本项目继续我们的研究提供的服务，选择，和医疗质量下的MA和如何 所有这些都随着新政策的实施而改变。通过继续补充存量和流量 我们使用行政和管理两种方法对MA和TM人群的健康风险进行了比较， 调查数据，我们将澄清支付的变化如何影响MA和TM的性能。并通过 从Truven MarketScan以及其他几个服务于此的健康计划中纳入数据， 市场，我们将能够第一次检查定价MA计划从供应商获得，并研究如何 这些价格随着时间的推移而变化，并与供应商集中度等市场因素有关。总之，在我们的 目前的计划项目，我们已经制定了方法来解决突出的政策问题，MA提出，我们 在偿还变得更加慷慨和千年评估正在扩大的时候解决了这些问题， 现在，我们可以将我们的方法应用于更严格的报销政策，在这种政策中，成功的ACO可能 但是，我们决定将其转换为MA计划。