Medicare in a Restructured Delivery System

描述（由申请人提供）：在医疗保险计划中成功整合融资和护理是卫生政策的最重要目标，可以说，具有强大的预算影响，是当今美国社会和财政政策的最重要目标。目前，医疗保险通过医疗保险优势（MA）计划促进综合护理，目前受益人注册率达到29%的历史最高水平。过去的增长是以高支付率为代价的，这在很大程度上转移了医疗保险计划和纳税人从整合中获得的任何收益。然而，支付率最近有所降低，阻碍了硕士入学人数的进一步扩大。例如，2012年医疗保险受托人报告预计，到2020年，MA入学率将下降到17%。此外，最昂贵的医疗保险受益人，以及那些一体化最能提供的人，所谓的“双重杀手”，加入一体化计划的频率要低得多，尽管这种情况正在开始改变。按照目前的结构，千年评估方案并没有解决将大量受益人转移到综合护理计划、提高其护理质量、同时节省方案资金的难题。医疗保险需要创新，需要健全的经济分析来评估当前的举措，并为修改或新方法提供科学依据。医疗保险是创新的提供者支付与计划，如责任护理组织（ACO）计划，旨在感觉像传统的医疗保险（TM）的受益人。ACO的参与是自愿的，提供者团体通过整合实现效率获得经济奖励。ACO是否可以在成本或质量方面改进目前的TM和MA医疗保险替代方案，并对受益人和提供者的奖励进行轻微调整，这是一个悬而未决的问题，需要立即给出有效的答案。然而，重要的是，除了ACO之外，还必须考虑关于医疗保险整合的新想法。该计划项目申请列出了一个前瞻性的研究议程，包括三个领域：1）对当前举措的创新和全面分析，2）对当前整合形式的严格研究，正如我们的研究所示，MA计划近年来表现出了更好的表现，3）对创新受益人和提供者支付政策的研究。

DESCRIPTION (provided by applicant): Successful integration of financing and care in the Medicare program is the single most important objective of health policy, and arguably, with its powerful budgetary implications, of social and fiscal policy in the US today. Currently, Medicare promotes integrated care through the Medicare Advantage (MA) program, presently at an historic high in beneficiary enrollment of 29%. Past growth came at the cost of high payment rates, which largely transferred any gains from integration away from the Medicare program and taxpayers. Payment rates have recently been reduced, however, handicapping further expansion of MA enrollment. The 2012 Medicare Trustees Report, for example, projects MA enrollment will fall to 17% by 2020. Furthermore, the most costly Medicare beneficiaries, and the ones for whom integration has the most to offer, the so-called "dual eligibles," have joined integrated plans much less frequently, though that is beginning to change. As currently constituted, the MA program has not solved the riddle of moving large numbers of beneficiaries to integrated care plans, improving the quality of their care, and at the same time saving program funds. Medicare needs innovation, and it needs sound economic analysis to evaluate current initiatives and provide the scientific basis for modifications or new approaches. Medicare is innovating in provider payment with programs such as the Accountable Care Organization (ACO) programs, designed to feel like Traditional Medicare (TM) to beneficiaries. ACO participation is voluntary for provider groups with financial rewards for achieving efficiencies through integration. Whether ACOs can improve on the current Medicare alternatives of TM and MA with respect to either cost or quality with a light touch on beneficiaries and rewards for providers is an open question to which an immediate valid answer is needed. Importantly, however, new ideas about integration in Medicare in addition to ACOs must be considered. This Program Project application lays out a forward-looking research agenda encompassing three areas: 1) innovative and comprehensive analyses of current initiatives, 2) rigorous research on the current form of integration, the MA program which, as our research has shown, has demonstrated improved performance in recent years, and, 3) research on innovative beneficiary as well as provider payment policy.