■大多数符合双重资格的Medicare-Medicaid受益人都参加了分叉保险计划,这些计划支付了不同的护理组成部分。因此,政策制定者正在优先考虑扩大管理医疗保险和医疗补助福利和支出的综合护理计划(ICPs)。
■为了审查ICP与医疗保健支出之间关联的证据,质量,利用率,以及双重符合条件的受益人中的患者结果。
对PubMed/MEDLINE(2010年1月1日至2023年11月1日)和GoogleScholar(2010年1月1日至2023年10月1日)进行了搜索,并添加了美国联邦和州政府网站的报告。评估了三类ICPs:老年人全包护理计划(PACE),医疗保险-医疗补助计划(MMPs),以及完全集成的双重合格特殊需求计划(FIDE-SNP)和相关模型,使Medicare和Medicaid覆盖范围保持一致。审查包括评估受益人双重资格和注册的全面医疗补助的研究;将ICP与非整合安排进行比较;并评估利用率,消费,护理协调,患者体验,或100名或更多受益人的健康。
■总之,26项ICP评估符合纳入标准,并纳入分析:5项PACE,13的MMPs,和8个FIDE-SNP和其他对齐模型。证据通常表明,PACE(4项研究中的3项)和FIDE-SNP以及相关的对齐模型(5项研究中的3项)中长期疗养院的减少相关,但在MMP的评估中却参差不齐。9项MMPs研究中的4项和3项FIDE-SNPs研究中的2项发现门诊使用较高,尽管其他研究显示没有差异。医疗补助支出的证据有限,而10项MMP研究中有8项显示这些计划与较高的Medicare支出之间存在关联.关于护理协调和住院的证据参差不齐或尚无定论,不足以评估患者的满意度,健康,和受益子群体的结果(例如,患有严重精神疾病的人)。此外,与非整合模型相比,ICPs参与者之间的未测量差异导致的偏倚控制能力有限.
■本系统综述发现了关于ICP和支出的证据的可变性和差距,质量,利用率,和结果。研究发现,一些ICP与长期养老院入院人数的减少有关,和几个确定的增加门诊护理。然而,MMPs主要与较高的Medicare支出有关。其他结果的证据有限或不确定。需要研究解决这些证据差距,以指导正在进行的努力,以整合双重资格受益人的覆盖范围和护理。
UNASSIGNED: Most dual-eligible Medicare-
Medicaid beneficiaries are enrolled in bifurcated insurance programs that pay for different components of care. Therefore, policymakers are prioritizing expansion of integrated care plans (ICPs) that manage both Medicare and
Medicaid benefits and spending.
UNASSIGNED: To
review evidence of the association between ICPs and health care spending, quality, utilization, and patient outcomes among dual-eligible beneficiaries.
UNASSIGNED: A search was conducted of PubMed/MEDLINE (January 1, 2010, through November 1, 2023) and Google Scholar (January 1, 2010, through October 1, 2023) and augmented with reports from US federal and state government websites. Three categories of ICPs were evaluated: Programs of All-Inclusive Care for the Elderly (PACE), Medicare-Medicaid Plans (MMPs), and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) and related models aligning Medicare and Medicaid coverage. The
review included studies that evaluated beneficiaries dually eligible for and enrolled in full
Medicaid; compared an ICP to a nonintegrated arrangement; and evaluated utilization, spending, care coordination, patient experience, or health for 100 or more beneficiaries.
UNASSIGNED: In all, 26 ICP evaluations met the inclusion criteria and were included in the analysis: 5 of PACE, 13 of MMPs, and 8 of FIDE-SNPs and other aligned models. Evidence generally showed associated reductions in long-term nursing home stays in PACE (3 of 4 studies) and FIDE-SNPs and related aligned models (3 of 5 studies) but was mixed in evaluations of MMPs. Four of 9 studies of MMPs and 2 of 3 studies of FIDE-SNPs found higher outpatient use, although other studies showed no difference. Evidence on Medicaid spending was limited, whereas 8 of 10 studies of MMPs showed an association between these plans and higher Medicare spending. Evidence was mixed or inconclusive regarding care coordination and hospitalizations, and it was insufficient to evaluate patient satisfaction, health, and outcomes in beneficiary subgroups (eg, those with serious mental illness). Furthermore, studies had limited ability to control for bias from unmeasured differences between enrollees of ICPs compared with nonintegrated models.
UNASSIGNED: This systematic
review found variability and gaps in evidence regarding ICPs and spending, quality, utilization, and outcomes. Studies found some ICPs were associated with reductions in long-term nursing home admissions, and several identified increases in outpatient care. However, MMPs were primarily associated with higher Medicare spending. Evidence for other outcomes was limited or inconclusive. Research addressing these evidence gaps is needed to guide ongoing efforts to integrate coverage and care for dual-eligible beneficiaries.