Resource Use and Quality of Care in Medicare Advantage

医疗保险优势中的资源利用和护理质量

• 批准号: 10651897
• 负责人: Jeah Jung
• 金额: $ 63.93万
• 依托单位: GEORGE MASON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10651897
• 关键词: Acute myocardial infarction; Caring; Complex; Contracts; Data; Decision Making; Diabetes Mellitus; Disease Progression; Enrollment; Growth; Guidelines; HCV Liver Disease; Health; Incentives; Intervention; Malignant Neoplasms; Managed Care; Medicare; Medicare claim; Methods; Multiple Sclerosis; Outcome; Outpatients; Patient Care; Patient Preferences; Patients; Performance; Population; Primary Care; Primary Care Physician; Privatization; Provider; Quality of Care; Research; Resources; Rheumatoid Arthritis; Risk Adjustment; Role; Sampling; Service provision; Services; Specialist; Standardization; Treatment Protocols; Validation; Work; beneficiary; care coordination; care delivery; cost; cost shifting; financial incentive; improved; insight; payment; primary care provider; programs; standardized care; traditional care

Project Summary Medicare Advantage (MA) is a private alternative to the Traditional Medicare (TM) program. MA has grown substantially in recent years, covering more than one-third of the Medicare population. MA is Medicare’s most important effort to create financial incentives for providers to deliver efficient care. Whether MA delivers care more efficiently than TM has long been an important inquiry. However, the existing work is limited in important ways. Notably, it provides little information on MA’s care provision for patients with serious and complex conditions, whose care relies heavily on specialists (“specialist- heavy conditions”). This is a significant gap because those conditions have serious health outcomes and high costs. In addition, the existing work shows that MA reduces costs by shifting care provision toward services delivered by primary care physicians (PCPs), but the work offers little insight into whether those shifts are a viable option to deliver efficient care for specialist-heavy conditions. This project will provide the first evidence on MA performance for specialist-heavy conditions – key information needed to assess implications of MA growth for patient care. The study will compare resource use and quality of care between MA and TM for five specialist-heavy conditions that have important cost and health impacts: two conditions where MA’s ability to modify the amount of PCP care is limited due to care standardization and three conditions that present opportunities for MA to increase PCP involvement in care compared with TM. The project will examine whether MA performs better than TM when it shifts care provision toward PCP services. It will thus validate whether a channel by which MA improves efficiency in care is viable for specialist-heavy conditions. This is a key to identifying opportunities to improve care delivery for those conditions. The study will address sample selection related to MA enrollment using an instrumental variable (IV) approach – a rigorous method to obtain unbiased estimates.

项目摘要 医疗保险优势（MA）是传统医疗保险（TM）计划的私人替代方案。马 近几年来，这一数字大幅增长，覆盖了超过三分之一的医疗保险人口。MA是 医疗保险最重要的努力是为提供者提供高效护理提供经济激励。 MA是否比TM更有效地提供护理长期以来一直是一个重要的研究。但 现有工作在重要方面受到限制。值得注意的是，它几乎没有提供关于MA护理提供的信息 对于病情严重和复杂的病人，他们的护理在很大程度上依赖于专家（“专家”）， 重条件”）。这是一个巨大的差距，因为这些疾病会导致严重的健康后果 和高成本。此外，现有的工作表明，MA通过转移护理提供来降低成本 对初级保健医生（PCP）提供的服务，但这项工作提供了很少的见解， 这些转变是否是一个可行的选择，以提供有效的照顾，专科医生密集的条件。这 该项目将提供关于MA性能的第一个证据，用于特殊重型条件-关键 评估MA增长对患者护理的影响所需的信息。该研究将比较 资源使用和护理质量之间的MA和TM的五个专家重的条件， 重要的成本和健康影响：MA改变PCP护理量的能力的两个条件 由于护理标准化和三个条件的限制， PCP参与护理与TM相比。该项目将研究千年评估是否优于 TM将护理提供转向PCP服务。因此，它将验证是否有一个渠道， MA提高了护理效率，适用于专科医生密集的情况。这是识别 改善这些条件的护理提供的机会。研究将涉及样本选择 使用工具变量（IV）方法-一种严格的方法来获得 无偏估计