Resource Use and Quality of Care in Medicare Advantage

项目摘要 Medicare Advantage(MA)是传统Medicare(TM)计划的私人替代方案。马云有 近年来大幅增长，覆盖了三分之一以上的医疗保险人口。马是 联邦医疗保险最重要的努力是为提供者提供有效的医疗服务提供财务激励。 长期以来，MA是否比TM更有效地提供护理一直是一个重要的问题。然而， 现有的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的护理服务的信息 对于病情严重和复杂的患者，他们的护理在很大程度上依赖于专科医生(“专科医生- 恶劣的条件“)。这是一个很大的差距，因为这些情况会造成严重的健康后果 而且成本很高。此外，现有的工作表明，MA通过转移护理提供来降低成本 初级保健医生(PCP)提供的服务，但这项工作几乎没有提供对 这些转变是否是为专科医生繁重的疾病提供有效护理的可行选择。这 该项目将为专家-重型条件-关键-MA的绩效提供第一个证据 评估MA增长对患者护理的影响所需的信息。这项研究将比较 MA和TM之间对于以下五种专科重度疾病的资源使用和护理质量 重要的成本和健康影响：MA有能力修改PCP护理金额的两个条件 由于护理标准化和三个为MA提供机会增加的条件而受到限制 与TM相比，PCP在护理方面的参与度。该项目将检查MA的表现是否比 当它将护理提供转向PCP服务时，TM。因此，它将验证通道是否通过哪个通道 MA提高了护理效率，适用于专科医生较多的情况。这是识别 改善这些疾病的护理服务的机会。这项研究将涉及样本选择 与使用工具变量(IV)方法的硕士招生相关--这是一种获得 公正的估计。

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.