Resource Use and Quality of Care in Medicare Advantage

George Mason University, Fairfax VA

Investigators

Linked publications, trials & patents

Abstract

Project Summary/Abstract Medicare Advantage (MA) is a private alternative to the Traditional Medicare (TM) program. MA has substantially grown during the past decade, and it currently enrolls 48% of the Medicare population. As MA plays an increasingly large role in Medicare, it is important to assess MA performance relative to TM. However, evidence is scarce on how MA provides care for patients with serious and costly conditions. Alzheimer’s Disease and Related Dementias (ADRD) are debilitating and complex conditions that bring significant burdens to patients and society. Previous studies report that individuals with ADRD are high users of health services and have increased risk of inappropriate care and adverse health events. It also indicates differences in service utilization and health outcomes between White and racial/ethnic minority patients with ADRD. However, the existing work on ADRD care is limited to examining ADRD patients in TM. Few studies examined how MA provides care for enrollees with ADRD. This is a significant gap in the literature given the continued growth of MA and a disproportionate share of racial/ethnic minority enrollees in MA. Information on care and outcomes of ADRD patients in MA relative to TM is critical to assess implications of the growth of MA for patient care. In addition, information about whether MA narrows disparities in care for ADRD patients across race/ethnicity groups is essential to draw health equity implications of the growth of MA. This proposed study will provide the first evidence on these important inquiries. Specifically, we will 1) compare care patterns and outcomes of ADRD patients between MA and TM.; and 2) examine racial/ethnic disparities in care patterns and outcomes of ADRD patients in MA relative to TM. Using nation-wide MA and TM claims data, we will examine a wide set of health service use, quality of care, and health outcomes relevant to Medicare beneficiaries with ADRD. Relevance to ADRD: Both specific aims of the proposed application focus on ADRD.