将双重符合条件的特殊需要计划的HEDIS绩效与双重符合条件的人员的其他保险类型进行比较
Amelia M Haviland1,2, Megan Mathews3, Steven C Martino1
1RAND Corporation, Pittsburgh, PA 15213, United States.
Health affairs scholar
|May 17, 2024
概括
医疗保险优势双重符合条件的特殊需求计划 (D-SNPs) 和其他MA计划为双重符合条件的个人提供比收费医疗保险更好的临床质量. 在关键质量指标中,D-SNP表现最高.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 老年学是一门学科.
背景情况:
- 双重资格的个人面临着独特的挑战,收入,资产较低,医疗保健需求更高.
- 常见的医疗保险覆盖方案包括医疗保险优势 (MA) 双重符合条件的特殊需求计划 (D-SNP),非D-SNP MA计划和服务费 (FFS) 医疗保险.
- 之前的研究没有对这三个覆盖类型的临床质量进行比较.
研究的目的:
- 为了比较三种医疗保险覆盖类型的双重资格个体的临床护理质量:D-SNP,非D-SNP MA计划和FFS医疗保险.
- 确定哪种覆盖类型为这个弱势群体提供优越的医疗保健结果.
主要方法:
- 使用后勤回归分析来比较覆盖类型.
- 检查了六个医疗保健有效性数据和信息集 (HEDIS) 的临床质量指标.
- 数据来自MA和FFS医疗保险的索赔文件.
主要成果:
- 在所有六个HEDIS措施上,D-SNP和非D-SNPMA计划都显著超过了FFS医疗保险.
- MA计划显示,两个措施的优势为5个百分点,四个措施的优势为18-34个百分点.
- 对于具有最大收益的四项措施,D-SNP计划显示了与非D-SNP MA计划相比的额外3-8个百分点的业绩改善.
结论:
- 医疗保险优势计划,特别是D-SNP,与传统的服务费医疗保险相比,为双重符合条件的个人提供更优质的临床护理.
- 调查结果表明,在D-SNP注册可能会导致医疗保险和医疗补助保险覆盖的个人更好的健康结果.
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