The impact of Medicare Advantage on Health Care, Management of Comorbid Conditions, and Potentially Inappropriate Medication Use, for Beneficiaries with Alzheimer's Disease and Its Related Dementias

项目摘要/摘要 美国有600多万成年人患有阿尔茨海默病和阿尔茨海默病 相关痴呆症(ADRD)，预计到2050年人口将翻一番。医疗保险费用 与AD/ADRD患者相关的风险是那些 如果没有，患有AD/ADRD的受益人的医疗保险总支出预计将达到 2050年为5840亿美元。ADRD患者还具有较高的合并症复杂性 护理的条件和协调。有证据表明可能不合适或不太理想 照顾患有ADRD的个人。Medicare Advantage(MA)提供了潜在的机会 提高ADRD患者的治疗效率和质量。因为MA计划 从联邦医疗保险获得每月首付，他们有很强的经济动机 管理慢性病，避免不必要的医疗保健使用。然而，MA计划 控制成本的激励措施也可能导致减少对投保人的有益护理 AD/ADRD。先前的研究表明，硕士注册与较低的医疗保健水平有关 ADRD个体的使用率，但结果是基于 MA和TM之间自我报告的结果，这可能会有偏差的估计，如果MA 参与者在未被观察到的方面与TM参与者不同。随着医疗保险份额的不断增长 对于参加MA的受益人，重要的是了解MA承保范围对 ADRD受益者的卫生保健使用和结果。我们提议的项目将使用 七个州硕士入学人数的外生变化改变了公共退休人员的健康状况 从TM和强制性MA计划的补充计划中受益(或在一个州，从 2016-2019年强制性MA计划到TM覆盖)。我们将利用这些自然实验， 以及TM和MA参与者的综合Medicare数据，以估计原因 医疗保险覆盖面对医疗保健使用、并存疾病管理的影响，可能 不适当的药物使用和多药制，以及对患有 阿德勒。这些结果将提供有关硕士注册的相对好处和坏处的见解 为这一弱势群体提供重要证据，为政策制定者权衡 医疗保险优势的更广泛扩展。

Project Summary / Abstract Over 6 million adults in the U.S. are living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (ADRD), a population estimated to double by 2050. Medicare costs associated with individuals with AD/ADRD are more than three times higher than for those without and the total Medicare spending for beneficiaries with AD/ADRD is projected to reach $584 billion in 2050. People with ADRD are also characterized by higher complexity of comorbid conditions and coordination of care. There is evidence of potentially inappropriate or suboptimal care for individuals with ADRD. Medicare Advantage (MA) provides a potential opportunity to improve the efficiency and quality of treatment for individuals with ADRD. Because MA plans receive capitated monthly payments from Medicare, they have strong financial incentive to manage chronic conditions and avoid unnecessary health care use. However, MA plans' incentives to control costs could also lead to reduction in beneficial care for enrollees with AD/ADRD. Prior research suggest that MA enrollment is associated with lower healthcare utilization for ADRD individuals, but the results were based on cross-sectional comparisons in self-reported outcomes between MA and TM, which could have biased estimates if MA enrollees differed from TM enrollees in unobserved ways. With the growing share of Medicare beneficiaries enrolled in MA, it is important to understand the causal effects of MA coverage on health care use and outcomes for beneficiaries with ADRD. Our proposed project will use plausibly exogenous variation in MA enrollment in seven states that shifted public retiree health benefits from TM with supplemental plans to mandatory MA plans (or in one state, from a mandatory MA plan to TM coverage) in 2016-2019. We will use these natural experiments, along with comprehensive Medicare data for TM and MA enrollees, to estimate the causal effects of MA coverage on health care use, management of comorbid conditions, potentially inappropriate medication use and polypharmacy, and institutionalization for individuals with ADRD. These results will provide insights on the relative benefits and harms of MA enrollment for this vulnerable population and contribute important evidence to policymakers weighing broader expansions of Medicare Advantage.