Detection and treatment of breast and colorectal cancer in dual eligible beneficiaries in the Medicare Sharing 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是社会和临床上的弱势群体，他们 占这两个项目支付的医疗支出的比例不成比例。双重资格的人有一个 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。双重登记的受益人的癌症预后也更差。他们不太可能 接受推荐筛查的人，在癌症诊断后接受明确治疗的可能性较小，以及 有更高的癌症特异性死亡风险。有双重资格的人存在复杂的社会和医疗保健需求 有效地向这些患者提供高质量的癌症护理是一个挑战。 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 双重资格仍然相对鲜为人知。 这项拟议的研究调查了MSSP ACO模式在多大程度上改善了癌症护理的质量 临床上复杂、脆弱的患者群体。目标1将评估MSSP ACOs对乳房和 65-75岁双重符合条件的人群中的结直肠癌筛查。目标1将涉及一种准实验方法，使用 倾向得分匹配的意向治疗差异-差异分析。AIM 2将使用一个时间- 对初次乳房或结直肠手术后开始治疗的时间进行比较的事件生存分析 18岁及以上的MSSP ACO双重合格患者的癌症诊断与18岁非ACO双重合格患者的癌症诊断 而且年纪也更大。AIM 3将评估18岁及以上双重符合条件的人在癌症治疗上的医疗保险支出 原发乳腺癌或结直肠癌。成本分析将使用广义线性模型与对数相连，伽马 分发。综合起来，这三个目标的结果将使政策制定者和提供者了解 基于价值的护理改革为双重登记受益人提供了更好的护理质量。 通过这项拟议的研究、概述的培训计划以及经验丰富的导师的指导 团队，申请者将接受使用大型二级数据集的各种定量方法的培训，加强 她的临床技能和思想，为不同的患者群体提供护理，并提高她的专业水平 这些技能将使她成为一名成功的独立学术内科医生兼科学家。

PROJECT SUMMARY/ABSTRACT Individuals dually enrolled in Medicare and Medicaid are a socially and clinically vulnerable population who account for a disproportionate amount of healthcare expenditures paid by both programs. Dual eligibles have a higher burden of disease compared to Medicare only beneficiaries, with more than 20% of individuals having multiple chronic conditions. Dually-enrolled beneficiaries 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 dual eligibles 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 dual eligibles remains relatively unknown. The proposed research investigates how much the MSSP ACO model improves quality of cancer care for a clinically complex, vulnerable patient population. Aim 1 will estimate the effect of MSSP ACOs on breast and colorectal cancer screening in dual eligibles ages 65-75. Aim 1 will involve a quasi-experimental approach using an intention-to-treat difference-in-difference analysis with propensity score matching. Aim 2 will employ a time- to-event survival analysis that will compare the time to treatment initiation after a primary breast or colorectal cancer diagnosis for MSSP ACO-attributed dual eligibles ages 18 and older to non-ACO dual eligibles ages 18 and older. Aim 3 will assess Medicare spending on cancer treatment for dual eligibles ages 18 and older with primary breast or colorectal cancer. Analysis of costs will use generalized linear models with a log-linked, gamma distribution. Taken together, the results of these three aims will inform policymakers and providers on whether value-based care reforms deliver better quality of care for dually enrolled beneficiaries. Through this proposed research, the outlined training plan, and the guidance of a highly experienced mentorship team, the applicant will be trained in various quantitative methods using large secondary datasets, strengthen her clinical skills and thinking for providing care to a diverse patient population, and enhance her professional skills that will make her a successful independent academic physician-scientist.