Medicare and Beneficiaries with Dementia

摘要 数以百万计的美国人已经或即将患上痴呆症，这对他们有潜在的可怕影响，他们的 家庭和医疗保险计划。据估计，痴呆症的受益人已经占到了五分之一 美元的医疗保险支出，然而医疗保险计划一直难以满足他们复杂的医疗和 支持性需求。研究人员为描述和改进痴呆症医疗保险受益人的护理所做的努力 由于难以识别患有痴呆症或认知障碍的人，接收受到了阻碍 索赔数据，但这些数据是目前唯一大量可用的关于联邦医疗保险受益人的数据 比例。先前的研究表明，许多受益人患有未被发现或未诊断的疾病，而其他人 完整的认知带来了基于虚假声明的诊断。因此，我们的首要目标是利用关联调查 根据一项经过验证的基于调查的调查，并声称有数据可以预测痴呆症的概率及其严重程度 参考标准。更好地识别痴呆症患者是获得更准确的 关爱这一重要人群的国家图景。这两个数据来源也是互补的；调查 数据有助于评估诊断不足以及基于声称的诊断真正代表痴呆症的可能性， 索赔数据支持大规模审查医疗保险计划。然后，我们将描述对 可用计划选项中的Medicare受益人：传统Medicare(TM)、Medicare Advantage(MA)、 在MA内部，有特殊需要计划(SNPs)。这项工作建立在我们现有的P01关于选择的研究基础上，该研究 结果表明，认知能力较差的受益人更有可能选择占主导地位的计划。在这 项目，我们将研究关于可能对痴呆症患者有利的选择的分类，例如， SNPs。最后，我们将考察不断变化的医疗保险计划中的痴呆症护理和结果 痴呆症受益人的付款和福利灵活性增加。例如，MA计划将收到 从2020年开始通过风险调整大幅提高痴呆症登记受益人的赔偿金 公式变化，这与由于慢性护理法案而在提供LTSS方面的新灵活性不谋而合。 此外，熟练护理设施的报销将在2019年底发生变化，以更多地权衡认知缺陷 治疗时间也减少了。我们的研究将提供迫切需要的证据，说明激励和 在一个变革的时代，为痴呆症受益人在联邦医疗保险中接受护理的计划灵活性。

ABSTRACT Millions of Americans have or will develop dementia, which has potentially dire implications for them, their families, and the Medicare program. Beneficiaries with dementia already account for an estimated one in five dollars of Medicare spending, yet the Medicare program has struggled to meet their complex medical and supportive needs. Researchers' efforts to describe and improve the care Medicare beneficiaries with dementia receive have been hampered by the difficulty of identifying those with dementia or cognitive impairments in claims data, yet such data are currently the only data on Medicare beneficiaries that are available on a large scale. Prior studies suggest that many beneficiaries have undetected or undiagnosed disease, while others with intact cognition carry a false claims-based diagnosis. Accordingly, our first aim is to leverage linked survey and claims data to predict the probability of dementia and its severity, according to a validated, survey-based reference standard. Better identification of those with dementia is a prerequisite to obtain a more accurate national picture of the care for this important population. The two data sources are also complementary; survey data help assess under-diagnosis and the probability that a claim-based diagnosis truly represents dementia, and claims data supports the examination of Medicare programs at scale. We will then describe the sorting of Medicare beneficiaries across available plan options: Traditional Medicare (TM), Medicare Advantage (MA), and within MA, Special Needs Plans (SNPs). This work builds on our existing P01 research on choice, which demonstrated that beneficiaries with less cognitive ability were more likely to choose a dominated plan. In this project, we will examine sorting with respect to options potentially advantageous for those with dementia, e.g., SNPs. Finally, we will examine dementia care and outcomes in the changing Medicare program as both payments for dementia beneficiaries and benefit flexibility increase. For example, MA plans will receive substantially larger payments for enrolled beneficiaries with dementia starting in 2020 through risk adjustment formula changes, which coincides with new flexibility in offering LTSS because of the CHRONIC Care Act. Additionally, reimbursement of skilled nursing facilities will change in late 2019 to weigh cognitive deficits more and therapy minutes less. Our study will provide critically needed evidence about the role of incentives and program flexibility for beneficiaries with dementia receiving care within Medicare in an era of change.