The impact of Medicare managed care on older patients with dementia and their family caregivers.

点击翻译按钮获取中文摘要

ABSTRACT The scope of Alzheimer’s disease and related Dementias (ADRD) in the United States is unprecedented, affecting 14 million Americans at an annual cost of $200 billion.1,2 Addressing the needs of patients with ADRD requires substantial long-term behavioral and social care supports not typically available under traditional fee- for-service insurance. Due to their cognitive limitations, older patients with ADRD may not know that other potentially beneficial insurance options are available to them. Managed care products may be expected to improve patient outcomes while restraining health care use. By helping patients, this might also alleviate need for caregiver support. Thus, managed care might offer critical benefits for ADRD patients and their caregivers. However, little is known about the role of managed care in dementia care. It is important to understand whether older individuals with ADRD are using managed care products, which ones they use, and the role of caregivers in such decisions. It is also important to understand the impact of managed care on health outcomes for older patients with ADRD including use of informal care. Given the burdens of dementia, and associated impacts on caregivers, there is a critical need to pursue research to address these knowledge gaps. Using longitudinal Medicare inpatient data, plus national survey data, the proposed research will use instrumental variables analysis to explore the impact of managed care on older adults with ADRD including receipt of caregiving. Innovation: The grant will be the first to rigorously examine the role of managed care programs on outcomes for a debilitating disease requiring self-management from older adults and their family caregivers. To do so, it will use a unique and robust mix of survey and claims data to examine managed care and dementia outcomes. These analyses will be conducted by an interdisciplinary study team with clinical and research expertise in dementia care, caregiving, and outcomes measurement as well as leaders in policy research. Finally, we have a robust dissemination strategy exploiting the strengths of our institutional resources for rapid dissemination. Impact: This project will leverage large national datasets and rare linkages between survey and administrative data to provide insights for clinicians and policymakers into improving coverage and care strategies for ADRD, and actionable methods that can support older individuals and their informal caregivers. It will inform insurers about the extent to which managed care is successful in addressing the needs of the ADRD population and help patients and caregivers learn select insurance products that are most beneficial for their health.