Use of post-acute care and outcomes among Medicare Advantage and fee-for-service beneficiaries

Medicare Advantage 和按服务收费受益人对急性后护理的使用和结果

• 批准号: 10390350
• 负责人: Robert Edward Burke
• 金额: $ 34.11万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10390350
• 关键词: Use; post; acute; care; outcomes

Project summary Post-acute care (PAC) is common, and costly, and may not lead to optimal health outcomes for older adults. However, it is unknown how to improve outcomes and/or lower costs, or value, of PAC. More than 40% of Medicare fee-for-service (FFS) beneficiaries receive PAC after hospitalization, predominantly in skilled nursing facilities (SNFs) and by home health (HH) agencies, at a cost of more than $60 billion annually. Unfortunately, around 1 in 4 is readmitted to the hospital within 30 days of discharge to PAC, and nearly half of beneficiaries in SNF fail to return to the community within 100 days of hospital discharge. The rapid expansion of Medicare Advantage (MA) provides an opportunity to evaluate a different approach to PAC utilization. More than one- third of all Medicare beneficiaries are now enrolled in Medicare Advantage (MA) plans, which receive capitated payments and take financial risk for the care needs of beneficiaries. MA plan directors confirm in interviews that PAC is a major focus of efforts to reduce care utilization and costs through four mechanisms: limiting use of PAC overall; steering beneficiaries to less expensive forms (HH) instead of more expensive forms (SNF); restricting choice of providers; and limiting PAC length of stay. Early reports suggest MA plans may strongly influence PAC utilization. Whether reductions in PAC utilization in MA improve PAC value is unknown. The limited existing literature has two main gaps: first, it does not adequately account for the substantial underlying differences in the MA and FFS populations. Second, it has focused on short-term outcomes, while PAC likely has a substantial impact on longer-term functional status and independence. Our overall goal is to inform patients, providers, and policymakers about ways to improve the value of PAC for all Medicare beneficiaries. To achieve this goal, we propose innovative analytic strategies that address limitations in the prior literature and allow accurate assessment of the use and outcomes of PAC in similar MA and FFS beneficiaries. Our aims are to: 1) Compare use of SNF and HH in similar MA and FFS beneficiaries after hospital discharge, and the impact of different mechanisms for limiting PAC utilization; 2) Compare PAC outcomes (community days, long-term institutionalization, rehospitalization, mortality) at 100 days and 1 year after hospital discharge in MA and FFS; and 3) Evaluate the effects of MA versus FFS enrollment on specific subpopulations of patients known to be at high risk for poor PAC outcomes. These results will provide novel insights into the effect of MA plans on PAC use and outcomes, identifying potential benefits or unintended consequences that can shape policy.

项目概要 急性后期护理（PAC）很常见，而且费用昂贵，并且可能无法为老年人带来最佳的健康结果。 然而，尚不清楚如何改善 PAC 的结果和/或降低成本或价值。超过40% 医疗保险按服务收费 (FFS) 受益人在住院后接受 PAC，主要是熟练护理人员 设施 (SNF) 和家庭健康 (HH) 机构，每年花费超过 600 亿美元。很遗憾， 大约四分之一的人在出院到 PAC 后 30 天内重新入院，近一半的受益人 SNF 出院后 100 天内未能返回社区。医疗保险快速扩张 优势 (MA) 提供了评估不同 PAC 使用方法的机会。不止一个—— 三分之一的 Medicare 受益人现已加入 Medicare Advantage (MA) 计划，该计划按人头收取 付款并承担财务风险以满足受益人的护理需求。 MA计划负责人在采访中确认 PAC 是通过四种机制减少护理利用率和成本的主要工作重点： 限制使用 PAC 整体；引导受益人选择较便宜的形式（HH）而不是较昂贵的形式（SNF）； 限制提供商的选择；并限制 PAC 的停留时间。早期报告表明 MA 计划可能会强烈 影响 PAC 利用率。 MA 中 PAC 利用率的降低是否会提高 PAC 值尚不清楚。这 有限的现有文献有两个主要差距：首先，它没有充分解释实质性的基础 MA 和 FFS 人群的差异。其次，它关注的是短期结果，而 PAC 可能 对长期功能状态和独立性产生重大影响。我们的总体目标是告知 患者、医疗服务提供者和政策制定者了解如何提高 PAC 对所有 Medicare 受益人的价值。 为了实现这一目标，我们提出了创新的分析策略，以解决现有文献中的局限性 并允许准确评估 PAC 在类似 MA 和 FFS 受益人中的使用和结果。我们的 目的是： 1) 比较出院后类似 MA 和 FFS 受益人对 SNF 和 HH 的使用情况，以及 限制 PAC 使用的不同机制的影响； 2) 比较 PAC 结果（社区日、 马萨诸塞州出院后 100 天和 1 年的长期住院治疗、再住院、死亡率 和FFS； 3) 评估 MA 与 FFS 入组对特定患者亚群的影响 已知 PAC 结果不佳的风险很高。这些结果将为 MA 的效果提供新的见解 计划 PAC 的使用和结果，确定潜在的好处或可能影响的意外后果 政策。