The Impact of Coordinating Medicare and Medicaid benefits for the dually-eligible

描述（由申请人提供）：2010年，美国大约900万符合双重资格的受益人的医疗支出达到了2.5万亿美元。然而，目前针对双重医疗的财政方案鼓励在医疗保险和医疗补助之间转移成本，这往往阻碍了提高医疗质量的努力，并可能限制这一弱势群体的获得。本研究的主要目的是比较综合管理医疗系统下提供的医疗服务的使用情况，并将双重合格受益人与参与传统服务收费计划的对照组的结果进行比较。我们将通过评估MassHealth高级护理方案（SCO）来检查这一点，SCO是一个综合的医疗保险和医疗补助管理护理计划，为马萨诸塞州的双重合格受益人提供两个计划提供的全部服务。具体目标是：目标1：评估参与老年护理方案对医疗服务利用的影响，并将住院、门诊和急症后护理与医疗保险FFS中的双重护理进行比较。目的2：确定参加老年护理方案是否与降低死亡率和减少30天再住院有关。本研究将通过较长时间的项目观察（2001-2008）和严格的计量经济学工具来检验选择偏差的影响。作为一种识别策略，将使用多种计量经济学方法，包括差异中的差异（DDD）。由于比较两个系统不同的群体，横断面回归和简单的差中差方法使估计容易受到选择偏差的影响。DDD模型允许通过纳入一个额外的对照组（非双重医疗保险FFS受益人）来评估治疗效果，该对照组不应受到SCO实施的影响。DDD规范将控制由国家间与SCO可用性无关的双元健康状态变化引起的混淆。考虑到当前的经济环境和不断增长的人口所需要的护理的复杂性，拟议的分析将提供证据，证明更好地协调医疗补助和医疗保险福利对双重资格的潜在收益。这项研究将解决政策制定者非常及时和重要的关注问题。研究结果将提供见解，从而更有效地为各种服务的双重合格受益人提供更高质量的护理。

DESCRIPTION (provided by applicant): Health expenditures for the roughly 9 million dually-eligible beneficiaries in the U.S. are now reaching a quarter of a trillion dollars in 2010. However, the current financial scheme for duals creates incentives to shift cost between Medicare and Medicaid, often hindering efforts to improve quality of care and potentially limiting access for this vulnerable sub population. The main purpose of this proposed study is to compare the use of medical services provided under an integrated managed care system and relate outcomes for dually-eligible beneficiaries with the controls who participate in traditional fee-for-service programs. We will examine this by evaluating MassHealth Senior Care Options (SCO), an integrated Medicare and Medicaid managed care program that offers the full collection of services provided by both programs for dual-eligible beneficiaries in Massachusetts. The specific aims are: Aim 1: To estimate the effects of participation in Senior Care Options on medical services utilization, with measures of inpatient, ambulatory and post-acute care compared to duals in Medicare FFS. Aim 2: To determine whether participation in Senior Care Options is associated with lower mortality and reduced 30 day re-hospitalization. The proposed study will examine the effects with a relatively long period of program observation (2001-2008) and rigorous econometric tools that mitigate selection bias. As an identification strategy, multiple econometric methods, including difference-in-difference-in-differences (DDD), will be utilized. Cross-sectional regression and simple difference-in-differences approaches leave estimates vulnerable to selection bias due to comparing two systemically different groups. A DDD model allows the effect of treatment to be assessed with the inclusion of an additional comparison group (non-dual Medicare FFS beneficiaries) that should not be affected by the implementation of SCO. The DDD specification will control for confounding arising from changes in health status of duals across counties which have nothing to do with SCO availability. Given the current economic environment and the complexity of care this growing population requires, the proposed analysis will provide evidence of the potential gains associated with better coordination of Medicaid and Medicare benefits for the dually-eligible. The study will address a very timely and important issue of concern for policymakers. The results will provide insights leading to higher quality of care provided more efficiently for dually-eligible beneficiaries for a wide range of services. PUBLIC HEALTH RELEVANCE: Dually-eligible beneficiaries, those who qualify for both Medicare and Medicaid, are generally sicker with fewer financial resources compared to other Medicare enrollees. They have a greater need for comprehensive health services, but often encounter a lack of continuity of care, inadequate administrative coordination between Medicare and Medicaid, no clear accountability for needed care, and a lack of smooth transitions between services. The findings from this project will demonstrate the influence of coordinating Medicare and Medicaid benefits through an integrated managed care program to promote higher quality of care while providing health services more efficiently for this vulnerable population.