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

医疗保险优势对阿尔茨海默病及其相关痴呆症受益人的医疗保健、共病管理以及潜在不适当药物使用的影响

• 批准号: 10525172
• 负责人: Victoria Shier
• 金额: $ 66.56万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525172
• 关键词: Adult; Alzheimer' s Disease; Alzheimer' s disease related dementia; Caring; Characteristics; Chronic; Chronic Disease; Communities; Complex; Cost Control; Data; Dementia; Disease Management; Drug Prescriptions; Enrollment; Geographic Locations; Growth; Health; Health Benefit; Health Services; Health Status; Healthcare; Hospitalization; Hospitals; Impaired cognition; Incentives; Individual; Inpatients; Institutionalization; Knowledge; Lead; Long-Term Care; Medical; Medicare; Natural experiment; Nursing Homes; Outcome; Outpatients; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Polypharmacy; Population; Prevention; Preventive service; Privatization; Quality of Care; Research; Services; Social Work; Time; Variant; Visit; Vulnerable Populations; adverse drug reaction; base; beneficiary; care coordination; comorbidity; cost; financial incentive; health care delivery; health care service utilization; health management; health service use; improved; insight; meetings; patient subsets; payment; programs; retiree; satisfaction; service providers; tool; treatment adherence

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.

项目摘要/摘要