Medicare Advantage Plan Choice and Selection Among Racial and Ethnic Minorities and Low-Income Seniors

摘要 我是一名少数民族老年学家--布朗大学卫生服务、政策和实践部以及老年学和医疗保健研究中心的卫生服务研究员。这份K01提案的目的是为我提供必要的额外培训和研究经验，以便成为一名独立调查员，研究患有阿尔茨海默病和相关痴呆症(ADRD)的弱势老年人的医疗保险决策。由于这些人可能更难做出复杂的决定，因此我们必须更好地了解他们如何选择Medicare Advantage(MA)计划以及他们为什么选择退出。我的培训计划侧重于五个相互关联的目标，以发展患有和不患有ADRD的老年人在决策模型和理论方面的专业知识，行为经济学和计量经济学方法，医疗保健和政策环境中的消费者选择，混合方法研究，以及为患有和不患有ADRD的老年人设计决策支持干预措施。为了实现这些目标，我组建了一个由导师和合作者组成的团队，这些导师和合作者来自一个由成熟的研究人员和实际研究经验组成的多学科小组，以满足我的培训需求。该团队由医学博士Amal Trivedi领导，他是一名健康服务研究员，在MA和福利计划设计对医疗服务使用和联邦医疗保险受益人所经历的结果的影响方面具有经验。共同导师和顾问包括：Momotazur Rahman博士，老龄化经济学和患者选择如何影响健康结果方面的专家；Renee Shield博士，在不同医疗保健环境中进行定性和混合方法研究的专家；Steven Sloman博士，决策专家；Gary Epstein-Lu博博士，精神病学家和ADRD和痴呆症护理专家；文森特·莫尔博士，实施和评估干预措施和临床试验的专家。我的培训活动与以下具体目标相结合，以了解患有痴呆症和非痴呆症患者的保险决策过程：1)确定患有痴呆症和非痴呆症的弱势群体对MA计划的选择质量；2)分析参加MA计划的不同类型痴呆症患者之间的转换；3)定性描述患有痴呆症和非痴呆症的老年人如何切换和退出MA，以及他们如何做出下一步选择。布朗大学为老年学和卫生服务研究提供了一个出色的科研环境，并提供了大量的专业发展机会。领导这项研究的教职员工是致力于学员成功的敬业导师。在获奖期间，本部门对我的持续培训和研究活动给予了最大的支持。在K01接近尾声时，我将很好地在第四年提交一份竞争性的R01，它将提出一项干预措施，以促进ADRD不同阶段的最佳决策，并为老年人和痴呆症患者简化医疗保险和治疗相关决策的选择。

ABSTRACT I am an ethnic minority gerontologist-health services researcher at the Department of Health Services, Policy, and Practice and the Center for Gerontology and Healthcare Research at Brown University. The purpose of this K01 proposal is to provide me with the additional training and research experience necessary to become an independent investigator studying health insurance decision-making among vulnerable seniors with Alzheimer’s disease and Related Dementias (ADRD). Since these individuals may have more difficulty making complex decisions, it is imperative that we better understand how they choose a Medicare Advantage (MA) plan and why they choose to disenroll. My training plan focuses on five interrelated aims to develop expertise in models and theory of decision-making among seniors with and without ADRD, behavioral economics and econometric methods, consumer choice in healthcare and policy environment, mixed-methods research, and design of decision-supportive interventions for older adults with and without ADRD. To achieve these goals, I have assembled a team of mentors and collaborators from a multi-disciplinary group of established researchers and practical research experience that addresses my training needs. The team is led by Amal Trivedi, MD., a health services researcher with experience in MA and the impact of benefit plan design on health services use and outcomes experienced by Medicare beneficiaries. Co-mentors and advisors include: Dr. Momotazur Rahman, an expert in the economics of aging and how patients’ choice affect health outcomes; Dr. Renee Shield, an expert in conducting qualitative and mixed-methods research in different health care settings; Dr. Steven Sloman, an expert in decision-making; Dr. Gary Epstein-Lubow, a psychiatrist and an expert in ADRD and dementia care; and Dr. Vincent Mor, an expert in implementing and evaluating interventions and clinical trials. My training activities have been integrated with the following Specific Aims to understand the insurance decision-making processes among people with and without dementia: 1) To determine quality of choice of MA plans among vulnerable groups with and without dementia; 2) To analyze switching among vulnerable populations with different types of dementia enrolled in MA plans; 3) To qualitatively describe how seniors with and without dementia switch and disenroll from MA and how they make their next choice. Brown University offers an outstanding environment for scientific research in Gerontology and Health Services Research, and numerous opportunities for professional development. The faculty members leading this research are dedicated mentors committed to the success of trainees. This department has given me its strongest support for my continued training and research activities during the award period. At the K01 nears conclusion, I will be well-positioned to submit a competitive R01 during Year 4 that will propose an intervention to facilitate optimal decision making in various stages of ADRD and strategies for simplifying choices for health insurance and treatment-related decisions for older adults, and individuals with dementia.