Policy options to improve access to memory care for disadvantaged individuals who are dually eligible for Medicare and Medicaid

改善具有医疗保险和医疗补助双重资格的弱势群体获得记忆护理的政策选择

• 批准号: 10729830
• 负责人: Soeren Mattke
• 金额: $ 53.63万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729830
• 关键词: Abnormal coordination; Accounting; Address; Adopted; Alzheimer' s Disease; Alzheimer' s disease related dementia; Cardiovascular Diseases; Caring; Characteristics; Chronic; Chronic Disease; Consultations; Cost Sharing; Counseling; Data; Dementia; Demography; Diabetes Mellitus; Diagnosis; Disease; Disparity; Disparity population; District of Columbia; Education; Educational Status; Elderly; Equilibrium; Ethnic Origin; Event; Face; Failure; Geography; Health Services Accessibility; Heterogeneity; High Prevalence; Impaired cognition; Impairment; Improve Access; Individual; Institution; Intervention; Low income; Measures; Medicaid; Medicare; Medicare Part B; Medicare/Medicaid; Modeling; Patients; Physicians; Policies; Policy Maker; Process; Provider; Race; Recommendation; Risk; Risk Factors; Scheme; Services; Smoking; Specialist; System; Transportation; Variant; Visit; Wait Time; Work; access disparities; aged; beneficiary; burden of illness; care systems; cognitive testing; copayment; dementia risk; density; dual eligible; ethnic minority; falls; health literacy; high risk; human old age (65+); improved; insight; medical specialties; memory care; multiple chronic conditions; patient navigation; payment; racial minority; risk prediction; sex

Project Summary/Abstract The proposed study will be the first to decompose how different institutional-, state- and patient-level factors interfere with the access of elderly individuals dually eligible for Medicare and Medicaid (“duals”) to memory care and provide actionable and state-specific policy guidance on how to address these obstacles. Duals have a higher risk of Alzheimer’s disease (AD) and related dementias (ADRD), given their lower income and education, as well as higher prevalence and worse management of chronic conditions. Having partial Medicaid coverage, duals face the well-known reluctance of physicians to see them, because of lower payment rates compared to those for Medicare-only beneficiaries, and administrative complexity given that providers need to bill Medicaid and Medicare separately. Patient- level factors, such as limited ability to navigate two separate benefit schemes, compound the challenge. Consequently, duals are less likely to be diagnosed, counseled, and treated for cognitive impairment in spite of their higher disease burden. As disease-modifying AD treatments are likely to become available soon, understanding and addressing these obstacles becomes pressing to avoid potentially widening existing disparities. The proposed study has three aims: Investigate the association of disparities in receiving memory care between duals of similar predicted risk of cognitive impairment with patient- (e.g., race/ethnicity) and state-level factors (e.g., provider density). Causally decompose the effects of physician payment rates, patient navigation, and administrative complexity on access to memory care for duals compared to non-duals with similar cognitive impairment risk. We will take advantage of differences in Medicaid rates across states and a 2022 policy reform that aims to improve patient navigation and reduce administrative complexity for physicians. Explore whether effects of physician payment rates, patient navigation, and administrative complexity on access to memory care are moderated by patient- and state-level drivers of disparities, and provide tailored and actionable policy guidance on how to effectively and efficiently improve access to memory care for duals to all 50 states and the District of Columbia.

项目总结/摘要 这项拟议的研究将是第一个分解不同的机构，国家和病人层面 影响老年人获得医疗保险和医疗补助双重资格的因素 （“政策”），并就如何解决 这些障碍。双胞胎患阿尔茨海默病（AD）和相关痴呆症（ADRD）的风险更高， 鉴于他们的收入和教育水平较低，以及慢性病的患病率较高和管理较差， 条件有部分医疗补助覆盖，面临着众所周知的医生不愿意看到 他们，因为与仅医疗保险受益人相比，支付率较低， 管理复杂性，因为提供者需要分别向医疗补助和医疗保险收费。病人- 职等因素，如驾驭两个不同福利计划的能力有限，使挑战更加复杂。 因此，患者不太可能被诊断、咨询和治疗认知障碍， 尽管他们的疾病负担更高。随着改善疾病的AD治疗可能变得可用， 很快，了解和解决这些障碍就变得紧迫起来，以避免潜在的扩大 存在的差距。拟议的研究有三个目标： 调查相似预测值的100名受试者之间在接受记忆护理方面的差异 患者认知障碍的风险（例如，种族/民族）和州一级的因素（例如，提供商 密度）。 因果分解的影响，医生支付率，病人导航，和行政 与具有相似认知能力的非癫痫患者相比， 减值风险。我们将利用各州医疗补助费率的差异和2022年政策 旨在改善患者导航和降低医生管理复杂性的改革。 探讨医生支付率、患者导航和管理复杂性的影响 对访问记忆保健是由病人和国家一级的差异驱动器缓和，并提供 关于如何有效和高效地改善记忆访问的量身定制且可操作的政策指导 向所有50个州和哥伦比亚特区提供护理服务。