Cancer detection and care for dually-enrolled beneficiaries in the Medicare Shared Savings Program

项目摘要/摘要 双重参加联邦医疗保险和医疗补助的个人(“双重”)是社会和临床上的弱势群体 他们在这两个项目支付的医疗支出中所占比例不成比例。二重奏有一个 与仅受益于医疗保险的人相比，疾病负担更高，超过20%的人患有 多种慢性病。双胞胎患者的癌症预后也更差。他们不太可能收到 推荐的筛查，不太可能在癌症诊断后接受明确的治疗，并且有 癌症特有死亡率的风险更高。二人组复杂的社会和医疗需求构成了一个挑战 有效地为这些患者提供高质量的癌症护理。 责任护理组织(ACO)努力为患者提供协调、高质量的护理，同时 包含付款人的费用。作为联邦医疗保险的主要ACO模式，联邦医疗保险共享储蓄计划 (MSSP)在提高医疗质量、为每位受益人节省资金以及照顾 临床上易受伤害的病人。MSSP是否提高了整个癌症连续过程的护理质量 二重奏仍然相对鲜为人知。 这项拟议的研究调查了MSSP ACO模式在多大程度上改善了临床癌症护理的质量 复杂、脆弱的患者群体。研究将比较MSSP归因于DUAL的癌症结果 没有接受MSSP ACO护理的二人组。目标1将评估MSSP ACOs对乳房的影响 并对结直肠癌筛查采用准试验性差异性分析。目标2将 采用事件发生时间生存分析比较乳房或结直肠手术后开始治疗的时间 癌症诊断。使用广义估计方程，目标3将评估医疗保险总额的差异 乳腺癌和结直肠癌患者在癌症治疗的第一年的花费。总而言之， 这项拟议研究的结果将向政策制定者和提供者提供关于基于价值的护理改革 为双重登记的人提供更高质量的乳腺癌和结直肠癌筛查和治疗服务 受益人。

PROJECT SUMMARY/ABSTRACT Individuals dually enrolled in Medicare and Medicaid (“duals”) are a socially and clinically vulnerable population who account for a disproportionate amount of healthcare expenditures paid by both programs. Duals have a higher burden of disease compared to Medicare only beneficiaries, with more than 20% of individuals having multiple chronic conditions. Duals also have worse cancer outcomes. They are less likely to receive recommended screening, are less likely to receive definitive treatment after a cancer diagnosis, and have a higher risk of cancer-specific mortality. The complex social and healthcare needs of duals present a challenge in effectively delivering high quality cancer care to these patients. Accountable care organizations (ACOs) strive to provide coordinated, high-quality care to patients while containing costs for payers. As Medicare’s predominant ACO model, the Medicare Shared Savings Program (MSSP) has shown promise in improving quality of care, generating savings per beneficiary, and caring for clinically vulnerable patients. Whether the MSSP increases the quality of care across the cancer continuum for duals remains relatively unknown. The proposed study investigates how much the MSSP ACO model improves quality of cancer care for a clinically complex, vulnerable patient population. Studies will compare cancer outcomes for MSSP-attributed duals to duals who did not receive care from the MSSP ACO. Aim 1 will estimate the effect of MSSP ACOs on breast and colorectal cancer screening of duals using a quasi-experimental difference-in-difference analysis. Aim 2 will employ a time-to-event survival analysis to compare the time to treatment initiation after a breast or colorectal cancer diagnosis. Using generalized estimating equations, Aim 3 will assess differences in total Medicare spending in the first year of cancer treatment for duals with breast and colorectal cancer. Taken together, the results of this proposed study will inform policymakers and providers on whether value-based care reforms deliver better quality of care in screening and treatment of breast and colorectal cancer for dually enrolled beneficiaries.