Private Medicare Plans and Health Outcomes for Older Adults

尽管私人医疗保险计划的参保率从2004年的12.8%上升到2019年的37.5%，但 大量美国老年人参加这些计划的后果尚不清楚。这是 特别关注高危患者，即患有特定慢性病的患者 出现不良后果的风险更高。私人医疗保险计划通常是管理型医疗计划，获得 每个计划加入者的首肯付款，因此面临着控制成本的财务激励。 尽管如果一些私人医疗保险计划能够改善，高风险患者可能会受益 通过护理协调或通过将患者引导到高质量的医疗保健提供者， 如果一些私人医疗保险计划通过降低成本来实现成本节约，他们也可能受到不利影响 提供必要的或预防性的护理。这份职业发展奖提案，“私人医疗保险” 老年人的计划和健康结果“，重点是利用来自私人医疗保险的新数据 遭遇索赔、州所有付款人索赔数据库和私人医疗保险风险调整系统-in 为了更好地了解私人医疗保险计划如何影响老年人的健康结果， 尤其是在高危患者中。这项工作将重点评估具体的性能 私人医疗保险计划--而不是对私人医疗保险计划进行整体评估-- 由于最近私人医疗保险计划提供了全面的医疗索赔数据，这是可能的。 检查特定于计划的影响将允许更全面地了解是否存在 专门的私人医疗保险计划，可以改善高危患者的健康结果。这项研究 目标包括三个方面：1)估计私人医疗保险计划对质量的具体计划影响 护理和患者结果，2)评估专门针对以下方面的私人医疗保险计划的绩效 改善高危患者的健康结果，以及3)使用预测方法来量化 私人医疗保险计划有可能进行有利的选择。这项工作将利用准 估计特定私人医疗保险计划的登记是否相关的实验方法 有更好的健康结果；例如，通过研究从雇主过渡的患者- 赞助计划到私人医疗保险计划，或从传统医疗保险转换到私人医疗保险计划的患者 医疗保险计划。该奖项还将支持针对以下三个职业目标的额外培训： 研究的目的是：1)发展医疗质量测量方面的专门知识，并改善 患者结局，2)获取高危患者的临床管理知识，3)建立 掌握用于预测和模拟健康结果的统计方法。这些目标将是 通过课程作业、指导、研讨会和研究，在一个生产力很高的 卫生经济学和卫生政策学者在一家领先的机构。

Although enrollment in private Medicare plans has risen from 12.8% in 2004 to 37.5% in 2019, the health consequences of large numbers of older Americans enrolling in these plans are not clear. This is of particular concern for high-risk patients, people with selected chronic conditions that place them at higher risk of adverse outcomes. Private Medicare plans are typically managed care plans that receive a capitated payment for each plan enrollee and therefore face financial incentives to control costs. Although high-risk patients could potentially benefit if some private Medicare plans are able to improve health outcomes through care coordination or by steering patients to high-quality health care providers, they could also be adversely impacted if some private Medicare plans achieve cost savings by reducing provision of necessary or preventive care. This Career Development Award proposal, “Private Medicare Plans and Health Outcomes for Older Adults,” focuses on leveraging new data—from private Medicare encounter claims, a state all-payer claims database, and the private Medicare risk adjustment system—in order to better understand how private Medicare plans impact health outcomes for older adults, particularly among high-risk patients. This work will focus on evaluating the performance of specific private Medicare plans—as opposed to evaluating private Medicare plans as a whole—something made possible by the recent availability of comprehensive health care claims data from private Medicare plans. Examining plan-specific effects will allow for a more complete understanding of whether there are specialized private Medicare plans that can improve health outcomes for high-risk patients. The research aims encompass three areas: 1) estimating plan-specific effects of private Medicare plans on quality of care and patient outcomes, 2) evaluating the performance of private Medicare plans that specialize in improving health outcomes for high-risk patients, and 3) using prediction methods to quantify the potential for favorable selection by private Medicare plans. This work will make use of quasi- experimental methods to estimate whether enrollment in specific private Medicare plans is associated with better health outcomes; for example, by studying patients who transition from an employer- sponsored plan to a private Medicare plan, or patients who switch from traditional Medicare to a private Medicare plan. This award will also support additional training toward three career goals that support the research aims: 1) developing expertise in measurement of health care quality and improvement of patient outcomes, 2) acquiring knowledge of clinical management of high-risk patients, and 3) building skills in statistical methods used for prediction and modeling health outcomes. These goals will be achieved through coursework, mentorship, seminars, and research, among a highly productive group of health economics and health policy scholars at a leading institution.