The impact of Medicare Advantage on Health Care, Management of Comorbid Conditions, and Potentially Inappropriate Medication Use, for Beneficiaries with Alzheimer's Disease and Its Related Dementias

项目总结/摘要 美国有超过600万成年人患有阿尔茨海默病和阿尔茨海默病 相关痴呆症（ADRD），估计到2050年人口将翻一番。医疗保险费用 与AD/ADRD个体相关的风险是那些 没有和总医疗保险支出的受益人与AD/ADRD预计将达到 2050年5840亿美元。ADRD患者的特征还在于合并症的复杂性更高， 护理条件和协调。有证据表明， 照顾ADRD患者。Medicare Advantage（MA）提供了一个潜在的机会， 提高ADRD患者的治疗效率和质量。因为MA计划 从医疗保险获得资本化的每月付款，他们有强烈的经济动机， 管理慢性病，避免不必要的医疗保健使用。然而，MA计划“ 控制成本的激励措施也可能导致参与者的有益护理减少， AD/ADRD。先前的研究表明，MA入学与较低的医疗保健相关 利用ADRD个人，但结果是基于横断面比较， MA和TM之间的自我报告结果，如果MA 入组者与TM入组者在未观察到的方面不同。随着医疗保险的份额不断增加， 因此，如果受益人参加了MA，重要的是要了解MA覆盖范围的因果影响， ADRD受益人的卫生保健使用和结果。我们的项目将使用 七个州的MA入学率的明显外源性变化改变了公共退休人员的健康状况 从TM中受益，包括强制性MA计划的补充计划（或在一个州， 2016-2019年强制性千年生态系统评估计划到TM覆盖率）。我们将利用这些自然实验， 沿着TM和MA登记者的全面医疗保险数据，以估计因果关系 MA覆盖对医疗保健使用的影响，共病状况的管理， 不适当的药物使用和多种药物，以及将患有 ADRD。这些结果将提供有关MA入组的相对益处和危害的见解 为这一弱势群体提供重要证据， 扩大Medicare Advantage的范围。

Project Summary / Abstract Over 6 million adults in the U.S. are living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (ADRD), a population estimated to double by 2050. Medicare costs associated with individuals with AD/ADRD are more than three times higher than for those without and the total Medicare spending for beneficiaries with AD/ADRD is projected to reach $584 billion in 2050. People with ADRD are also characterized by higher complexity of comorbid conditions and coordination of care. There is evidence of potentially inappropriate or suboptimal care for individuals with ADRD. Medicare Advantage (MA) provides a potential opportunity to improve the efficiency and quality of treatment for individuals with ADRD. Because MA plans receive capitated monthly payments from Medicare, they have strong financial incentive to manage chronic conditions and avoid unnecessary health care use. However, MA plans' incentives to control costs could also lead to reduction in beneficial care for enrollees with AD/ADRD. Prior research suggest that MA enrollment is associated with lower healthcare utilization for ADRD individuals, but the results were based on cross-sectional comparisons in self-reported outcomes between MA and TM, which could have biased estimates if MA enrollees differed from TM enrollees in unobserved ways. With the growing share of Medicare beneficiaries enrolled in MA, it is important to understand the causal effects of MA coverage on health care use and outcomes for beneficiaries with ADRD. Our proposed project will use plausibly exogenous variation in MA enrollment in seven states that shifted public retiree health benefits from TM with supplemental plans to mandatory MA plans (or in one state, from a mandatory MA plan to TM coverage) in 2016-2019. We will use these natural experiments, along with comprehensive Medicare data for TM and MA enrollees, to estimate the causal effects of MA coverage on health care use, management of comorbid conditions, potentially inappropriate medication use and polypharmacy, and institutionalization for individuals with ADRD. These results will provide insights on the relative benefits and harms of MA enrollment for this vulnerable population and contribute important evidence to policymakers weighing broader expansions of Medicare Advantage.