Health Policy Implication of Dual Enrollment in the VA and Medicare Advantage

描述(由申请人提供)： 对退伍军人医疗保健的预期影响这项研究将对退伍军人保险和非退伍军人医疗服务的使用情况、退伍军人管理局资助的成本以及所有双重参加联邦医疗保险优势(MA)计划的退伍军人保险参保人的护理质量进行全面评估。我们的初步调查结果表明，2009财年退伍军人管理局的所有用户中有11%同时参加了MA计划，退伍军人管理局在这一人群的医疗服务上花费了32亿美元(约占其运营预算的10%)。因此，对退伍军人管理局和其他联邦政策制定者来说，协调这两个管理医疗系统的融资和服务交付是至关重要的。该项目的目标是向联邦政府提供有关为退伍军人管理局和MA双重登记的人提供医疗保健的筹资和提供服务的政策。项目背景在美国，符合条件的成年人可以选择同时注册两个不同的管理型医疗系统：由Medicare和Medicaid服务中心管理的MA计划和由退伍军人健康管理局管理的退伍军人医疗保健系统。尽管退伍军人管理局可以收取向登记在私人健康计划中的退伍军人管理局用户提供的护理费用，但联邦法律禁止退伍军人管理局从联邦医疗保险资助的医疗计划中收取任何费用。双重投保可能会产生多余的联邦付款，并使患有复杂慢性疾病的参保者的护理支离破碎。很少有研究量化退伍军人管理局和退伍军人管理局双重登记的临床和经济后果。项目目标我们的主要目标是：(1)评估同时参加联邦医疗保险优势计划的退伍军人健康护理系统用户的医疗服务利用率和退伍军人管理局资助的成本；(2)比较退伍军人中同时参加退伍军人保险和医疗保险计划的三组退伍军人中糖尿病、心血管疾病和癌症筛查的护理质量：仅接受退伍军人保险计划护理的退伍军人、同时接受退伍军人保险和退伍军人保险计划护理的退伍军人；(3)了解分散的融资对退伍军人保险和联邦医疗保险优势双重参保人的医疗质量的影响。项目方法我们将合并从2004年到2013年的13个国家退伍军人管理局和医疗保险临床和管理数据集，以得出同时参加医疗保险优势计划的所有退伍军人保险参保人的人数。对于这个队列，我们将使用工具变量和倾向得分方法评估VA和Medicare Advantage中的门诊和急性住院护理的分布，使用平均成本方法评估VA资助的护理的总成本，以及分散的融资对双重登记退伍军人护理质量的影响。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare This study will provide a comprehensive national assessment of the use of VA and non-VA health services, VA-financed costs, and quality of care for all VA enrollees who are dually enrolled in a Medicare Advantage (MA) plan. Our preliminary findings indicate that 11% of all VA users in CY2009 were simultaneously enrolled in an MA plan and that the VA spent $3.2 billion (approximately 10% of its operating budget) on health services for this population. Therefore, the coordination of financing and service delivery across these two managed care systems is of vital interest to VA and other federal policymakers. The goal of this project is to inform federal policy regarding the financing and delivery of health care for persons who are dually enrolled in the VA and MA. Project Background In the United States, eligible adults may choose to enroll simultaneously in two distinct managed care systems: the MA program administered by the Centers for Medicare and Medicaid Services and the VA Healthcare System, administered by the Veterans Health Administration. Although the VA may collect reimbursements for care provided to VA users enrolled in private health plans, federal law prohibits the VA from collecting any reimbursements from Medicare-financed health plans. Dual enrollment may produce redundant federal payments and fragmentation of care for enrollees with complex chronic medical conditions. Few studies have quantified the clinical and economic consequences of dual enrollment in VA and MA. Project Objectives Our primary objectives are: (1) to assess the utilization and VA-financed costs of health care services for VA health care system users who are simultaneously enrolled in a Medicare Advantage plan; (2) to compare the quality of diabetes, cardiovascular, and cancer screening care among the following three groups of veterans who are dually enrolled in VA and MA: veterans who exclusively receive care in the VA, veterans who receive care in both VA and MA, and veterans who exclusively receive care in MA; (3) to understand the effect of fragmented financing on the quality of care among dual enrollees in VA and Medicare Advantage. Project Methods We will merge 13 national VA and Medicare clinical and administrative datasets from 2004 through 2013 to derive the population of all VA enrollees who were simultaneously enrolled in a Medicare Advantage plan. For this cohort, we will assess the distribution of ambulatory and acute inpatient care in the VA and Medicare Advantage, the total costs of VA-financed care using average-cost methods, and the effect of fragmented financing on the quality of care for dually enrolled veterans using both instrumental variable and propensity-score approaches.