Medicare in a Restructured Delivery System

描述(由申请人提供)：在医疗保险计划中成功地整合资金和护理是医疗政策的唯一最重要的目标，而且可以说，由于其强大的预算影响，当今美国的社会和财政政策。目前，联邦医疗保险通过联邦医疗保险优势(MA)计划促进综合护理，目前受益人参保率达到29%，创历史新高。过去的增长是以高付款率为代价的，这在很大程度上转移了医疗保险计划和纳税人从一体化中获得的任何收益。然而，支付费率最近有所降低，阻碍了硕士研究生入学人数的进一步扩大。例如，2012年的联邦医疗保险受托人报告预计，到2020年，MA的注册人数将下降到17%。此外，最昂贵的联邦医疗保险受益人，以及一体化最能带来好处的人，即所谓的“双重合格者”，参加一体化计划的频率要低得多，尽管这种情况正在开始改变。就目前的构成而言，MA计划并没有解决将大量受益人转移到综合护理计划、提高他们的护理质量、同时节省方案资金的谜题。医疗保险需要创新，它需要合理的经济分析来评估当前的举措，并为修改或新的方法提供科学基础。Medicare正在通过责任护理组织(Account Care Organization，ACO)等计划在提供者支付方面进行创新，旨在让受益人感觉像传统的Medicare(TM)。ACO的参与对于通过整合实现效率的提供商群体是自愿的，并获得经济奖励。ACOS能否在成本或质量方面改善目前的TM和MA的联邦医疗保险替代方案，同时对受益人和提供者的回报较少，这是一个悬而未决的问题，需要立即得到有效的答案。然而，重要的是，必须考虑在ACO之外的医疗保险中整合的新想法。本计划项目申请列出了包括三个方面的前瞻性研究议程：1)对当前计划的创新和全面分析，2)对当前整合形式的严格研究，我们的研究表明，MA计划近年来的表现有所改善，以及3)对创新受益者和提供商支付政策的研究。

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.