Affiliation:
1. Center for Health Systems Effectiveness Oregon Health & Science University Portland Oregon USA
2. Department of Health Systems Administration Georgetown University Washington DC USA
3. Department of Neurology Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
4. Division of General Internal Medicine University of Pennsylvania Philadelphia Pennsylvania USA
Abstract
AbstractBackgroundPolicymakers advocate care integration models to enhance Medicare and Medicaid service coordination for dually eligible individuals. One rapidly expanding model is the fully integrated dual eligible (FIDE) plan, a sub‐type of the dual eligible special needs plan (D‐SNP) in which a parent insurer manages Medicare and Medicaid spending for dually eligible individuals. We examined healthcare utilization differences among dually eligible individuals aged 65 years or older enrolled in D‐SNPs by plan type (FIDE vs non‐FIDE).MethodsUsing 2018 Medicare Advantage encounters and Medicaid claims of FIDE and non‐FIDE enrollees in six states (AZ, CA, FL, NY, TN, WI), we compared healthcare utilization between plan types, adjusting for enrollee characteristics and county indicators. We applied propensity score weighting to address differences between FIDE and non‐FIDE plan enrollees.ResultsIn our main analysis, which included all dually eligible individuals in our sample, we observed no significant difference in healthcare utilization between FIDE and non‐FIDE plan enrollees. However, we identified some differences in healthcare utilization between FIDE and non‐FIDE plan enrollees in subgroup analyses. For example, among home and community‐based service (HCBS) users, FIDE plan enrollees had 6.0 fewer hospitalizations per 1000 person‐months (95% CI: −7.9, −4.0) and were 7.0 percentage points more likely to be discharged to home (95% CI: 2.6, 11.5) after hospitalization, compared to non‐FIDE plan enrollees.ConclusionWhile we found no differences in healthcare utilization between FIDE and non‐FIDE plan enrollees when considering all dually eligible individuals in our sample, some differences emerged when focusing on subgroups. For example, HCBS users with FIDE plans had fewer hospitalizations and were more likely to be discharged to their home following hospitalization, compared to HCBS users with non‐FIDE plans. These findings suggest that FIDE plans may improve care coordination for specific subsets of dually eligible individuals.
Funder
National Institute on Aging
Reference40 articles.
1. CMS.Beneficiaries Dually Eligible for Medicare & Medicaid.2022. Accessed October 31 2022.https://www.cms.gov/outreach‐and‐education/medicare‐learning‐network‐mln/mlnproducts/downloads/medicare_beneficiaries_dual_eligibles_at_a_glance.pdf
2. Medicare and Medicaid: Conflicting Incentives for Long-Term Care
3. PenaM MohamedM BurnsA BiniekJ OchiengN ChidambaramP.A Profile of Medicare‐Medicaid Enrollees (Dual Eligibles).2023. Accessed October 31 2022. https://www.kff.org/medicare/issue‐brief/a‐profile‐of‐medicare‐medicaid‐enrollees‐dual‐eligibles/#:~:text=The%2012.5%20million%20people%20who from%20their%20state%20Medicaid%20program
4. MACPAC.Chapter 6: Improving Integration for Dually Eligible Beneficiaries: Strategies for State Contracts with Dual Eligible Special Needs Plan.2021. Accessed October 31 2022.https://www.macpac.gov/wp‐content/uploads/2021/06/Chapter‐6‐Improving‐Integration‐for‐Dually‐Eligible‐Beneficiaries‐Strategies‐for‐State‐Contracts‐with‐Dual‐Eligible‐Special.pdf
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献