专注于老年人的初级保健机构增加了医疗保险优势成员,特别是弱势群体的获取机会
Kaylyn E Swankoski1, Amanda Sutherland2, Emily Boudreau3
1Kaylyn E. Swankoski (kswankoski@humana.com), Humana Healthcare Research, Louisville, Kentucky.
Health affairs (Project Hope)
|September 3, 2024
概括
在医疗保险优势 (MA) 计划中,以人口为基础的支付鼓励专注于老年人的初级保健机构提供增强的护理和准入,特别是对于黑人和双重资格的受益人.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健政策 医疗保健政策
- 健康 公平 卫生 公平
背景情况:
- 在Medicare Advantage (MA) 中,以人口为基础的支付模式激励医疗服务提供者创新医疗服务.
- 这些模型有可能改善对服务不足的人群的护理,因为医疗保健费用往往超过补偿.
- 专注于老年人的初级保健机构越来越多地采用这些支付结构.
研究的目的:
- 调查基于人口的支付模式与MA的护理质量/公平之间的关联.
- 将专注于老年人的初级保健机构与其他接受不同支付结构的MA初级保健机构进行比较.
- 评估对历史上服务不足群体的获取和利用的影响.
主要方法:
- 分析了2021年来自462,872名MA受益人的数据.
- 针对老年人的初级保健机构 (主要是以人口为基础的支付) 与其他初级保健机构的比较.
- 调整后退分析以评估护理和公平差异.
主要成果:
- 专注于老年人的初级保健机构为更高比例的黑人和双重资格受益者提供服务.
- 与其他阿尔茨海默症患者相比,专注于老年人组织的患者获得了17%的初级保健访问.
- 在增强照顾和获取方面,这些差异在黑人和双重资格受益者中最为明显.
结论:
- 在MA内部,承担风险的组织正在通过加强护理和获取来适应支付动态.
- 基于人口的支付模式似乎与改善医疗服务和为服务不足的人群提供公平性有关.
- 对这些支付模式的进一步研究可以为减少MA健康差异的策略提供信息.
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