高需要的受益者在医疗保险优势和传统医疗保险的入学模式
Aig Unuigbe, Inna Cintina, Julia Sheriff
1KNG Health Consulting, LLC, 6116 Executive Blvd, Ste 770, North Bethesda, MD 20852.
The American journal of managed care
|April 11, 2024
概括
高需要的医疗保险受益者越来越多地在传统医疗保险 (TM) 中注册医疗保险优势 (MA) 和负责任的护理组织 (ACO). 这种转变会影响弱势群体的护理协调.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保险政策 医疗保险政策
- 医疗保健经济学 医疗经济学
背景情况:
- 高需求的医疗保险受益人需要密集护理协调.
- 了解招生模式对于资源分配和政策制定至关重要.
研究的目的:
- 评估高需要的受益者在医疗保险优势 (MA) 和传统医疗保险 (TM) 负责任的护理组织 (ACO) 和非ACO的医疗保险组织的入学情况.
- 从2016年到2019年分析高需要受益者入学趋势.
主要方法:
- 对Medicare索赔和MA遭遇数据的分析.
- 根据残疾,虚弱或复杂的慢性疾病确定高需要的受益人.
- 招生模式和受益人特征的描述性分析.
主要成果:
- 2019年,1800万高需要受益者 (32%的入学者) 在TM和MA中,比2016年增加100万,这是MA增长所推动的.
- 与MA (24%) 相比,TM ACO中受益人的比例更高 (38%).
- TM ACOs获得了近150万高需要的受益人,而TM非ACO损失了190万.
结论:
- 高需要的受益者越来越多地注册MA和TM ACO,远离TM非ACO.
- 老年人口的未来增长可能会增加照顾这些人的经济负担.
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