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Related Experiment Videos

Patient selection in the ESRD managed care demonstration.

Jennifer R Shapiro1, Dawn M Dykstra, Ron Pisoni

  • 1Centers for Medicare and Medicaid Services, Baltimore, MD, USA. jshapiro@cms.hhs.gov

Health Care Financing Review
|November 25, 2003
PubMed
Summary

The Centers for Medicare & Medicaid Services (CMS) demonstration for end-stage renal disease (ESRD) found that enrollees were healthier and younger. This suggests patient selection occurred in this costly population.

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Area of Science:

  • Health Services Research
  • Nephrology
  • Health Economics

Background:

  • The Centers for Medicare & Medicaid Services (CMS) initiated a managed care demonstration for end-stage renal disease (ESRD) patients.
  • Patient selection, where healthier individuals enroll in managed care, is a known phenomenon in Medicare.
  • ESRD patients represent a chronically ill and high-cost population, making patient selection a critical factor to study.

Purpose of the Study:

  • To assess patient selection within the CMS ESRD managed care demonstration.
  • To compare the health status and demographics of ESRD demonstration enrollees with a control group.

Main Methods:

  • Analysis of enrollment data from the CMS ESRD managed care demonstration.
  • Comparison of demographic and health characteristics between demonstration enrollees and a representative Medicare fee-for-service (FFS) comparison group from similar geographic areas.

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Main Results:

  • Enrollees in the ESRD managed care demonstration were found to be generally younger than the comparison group.
  • Demonstration enrollees were also healthier compared to the representative group of patients in the traditional Medicare FFS sector.

Conclusions:

  • The findings indicate that patient selection, characterized by younger and healthier enrollees, was present in the ESRD managed care demonstration.
  • This suggests that managed care programs in high-cost populations like ESRD may attract healthier individuals, potentially impacting cost and utilization analyses.