Aligning Medicaid and Medicare Advantage Managed Care Plans for Dual-Eligible Beneficiaries

2021 ◽  
pp. 107755872110189
Author(s):  
Laura M. Keohane ◽  
Zilu Zhou ◽  
David G. Stevenson
Keyword(s):  
Nursing Home ◽  
Managed Care ◽  
Prescription Drugs ◽  
Service Use ◽  
Medicare Advantage ◽  
Percentage Point Increase ◽  
Care Plans ◽  
Point Increase ◽  
Dual Eligible ◽  
Home Users

To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee’s aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions ( p = .048), 13.9 fewer prescription drugs per month ( p = .048), and 0.3 fewer nursing home users ( p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions ( p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.

Comparing Care for Dual-Eligibles Across Coverage Models: Empirical Evidence From Oregon

2017 ◽  
Vol 76 (5) ◽  
pp. 661-677 ◽  
Author(s):  
Hyunjee Kim ◽  
Christina J. Charlesworth ◽  
K. John McConnell ◽  
Jennifer B. Valentine ◽  
David C. Grabowski
Keyword(s):  
Managed Care ◽  
Financial Incentives ◽  
Service Use ◽  
Fee For Service ◽  
Care Plans ◽  
Dual Eligibles ◽  
Dual Eligible ◽  
Coverage Models ◽  
Substantial Heterogeneity

Dual-eligible beneficiaries or “duals” are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid. We found substantial heterogeneity in care across these five coverage models. We also found that duals in plans with aligned financial incentives for Medicare and Medicaid experienced more improvement in their care relative to those with nonaligned Medicare Advantage and Medicaid managed care plans. These results highlight the importance of developing policies that account for the heterogeneity of the dual population and their coverage options.

scholarly journals Ohio’s Dual Eligible Population: Effects of Program Design and Implementation on Care Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 453-454
Author(s):  
Katherine Abbott ◽  
Athena Koumoutzis ◽  
Jennifer Heston-Mullins
Keyword(s):  
Managed Care ◽  
Care Management ◽  
Program Design ◽  
Service Providers ◽  
Coordinated Care ◽  
Term Care ◽  
Care Plans ◽  
Opt Out ◽  
Dual Eligible ◽  
Documentation Systems

Abstract MyCare Ohio is a prospective blended managed care payment model program tasked to provide comprehensive and coordinated care to Ohio residents who are dully eligible for Medicare and Medicaid. To understand the administration and day-to-day implementation of care management within MyCare Ohio, n=75 interviews with a total of n=331 personnel from Area Agencies on Aging, Managed Care Plans, and service providers were conducted. Interviews were audio recorded, transcribed, and checked for accuracy. Data were analyzed by iterative reviews and deductive coding in Dedoose. Respondents provided insights on how care management activities are affected by program design features (e.g., ability to opt-out of the Medicare component), transitions between acute and long-term care settings, documentation systems and data-sharing, and high numbers of beneficiaries with behavioral health diagnoses. Implications for practice and policy will be discussed.

Dx For A Careful Approach To Moving Dual-Eligible Beneficiaries Into Managed Care Plans

2012 ◽  
Vol 31 (6) ◽  
pp. 1186-1194 ◽  
Author(s):  
Patricia Neuman ◽  
Barbara Lyons ◽  
Jennifer Rentas ◽  
Diane Rowland
Keyword(s):  
Managed Care ◽  
Care Plans ◽  
Dual Eligible

The Effect of Taxation and Corruption on Firm Growth: An Empirical Investigation for Vietnam

2016 ◽  
pp. 5-29
Author(s):  
Bich Le Thi Ngoc
Keyword(s):  
International Development ◽  
Firm Growth ◽  
Empirical Investigation ◽  
Manufacturing Firms ◽  
Economic Management ◽  
Tax Rate ◽  
Percentage Point Increase ◽  
Percentage Points ◽  
Point Increase ◽  
The Impact

The aim of this study is to analyze empirically the impact of taxation and corruption on the growth of manufacturing firms in Vietnam. The study employed pooled OLS estimation and then instrument variables with fixed effect for the panel data of 1377 firms in Vietnam from 2005 to 2011. These data were obtained from the survey of the Central Institute for Economic Management and the Danish International Development Agency. The results show that both taxation and corruption are negatively associated with firm growth measured by firm sales adjusted according to the GDP deflator. A one-percentage point increase in the bribery rate is linked with a reduction of 16,883 percentage points in firm revenue, over four and a half times bigger than the effect of a one-percentage point increase in the tax rate. From the findings of this research, the author recommends the Vietnam government to lessen taxation on firms and that there should be an urgent revolution in anti-corruption policies as well as bureaucratic improvement in Vietnam.

scholarly journals African American Unemployment and the Disparity in Periviable Births

2021 ◽  
Author(s):  
Ralph Catalano ◽  
Deborah Karasek ◽  
Tim Bruckner ◽  
Joan A. Casey ◽  
Katherine Saxton ◽  
...  
Keyword(s):  
African American ◽  
African American Women ◽  
Unemployment Rate ◽  
Racial Disparity ◽  
Live Births ◽  
Percentage Point Increase ◽  
Point Increase ◽  
The Us ◽  
Race Ethnicity ◽  
Hispanic White

AbstractPeriviable infants (i.e., born before 26 complete weeks of gestation) represent fewer than .5% of births in the US but account for 40% of infant mortality and 20% of billed hospital obstetric costs. African American women contribute about 14% of live births in the US, but these include nearly a third of the country’s periviable births. Consistent with theory and with periviable births among other race/ethnicity groups, males predominate among African American periviable births in stressed populations. We test the hypothesis that the disparity in periviable male births among African American and non-Hispanic white populations responds to the African American unemployment rate because that indicator not only traces, but also contributes to, the prevalence of stress in the population. We use time-series methods that control for autocorrelation including secular trends, seasonality, and the tendency to remain elevated or depressed after high or low values. The racial disparity in male periviable birth increases by 4.45% for each percentage point increase in the unemployment rate of African Americans above its expected value. We infer that unemployment—a population stressor over which our institutions exercise considerable control—affects the disparity between African American and non-Hispanic white periviable births in the US.

Health Insurance Status as a Predictor of Mode of Colon Cancer Detection but Not Stage at Diagnosis: Implications for Early Detection

2021 ◽  
pp. 003335492199917
Author(s):  
Lindsey A. Jones ◽  
Katherine C. Brewer ◽  
Leslie R. Carnahan ◽  
Jennifer A. Parsons ◽  
Blase N. Polite ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Health Insurance ◽  
Early Detection ◽  
Late Stage ◽  
Early Stage ◽  
Insurance Status ◽  
Stage At Diagnosis ◽  
Health Insurance Status ◽  
Percentage Point Increase ◽  
Point Increase

Objective For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. Methods Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. Results After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. Conclusions For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection.

scholarly journals Mendelian randomization analysis of arsenic metabolism and pulmonary function within the Hispanic Community Health Study/Study of Latinos

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Molly Scannell Bryan ◽  
Tamar Sofer ◽  
Majid Afshar ◽  
Yasmin Mossavar-Rahmani ◽  
H. Dean Hosgood ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Mendelian Randomization ◽  
Smoking History ◽  
Health Study ◽  
Arsenic Metabolism ◽  
Percentage Point Increase ◽  
Point Increase ◽  
Increased Risk ◽  
Genotype Information ◽  
Rice Consumption

AbstractArsenic exposure has been linked to poor pulmonary function, and inefficient arsenic metabolizers may be at increased risk. Dietary rice has recently been identified as a possible substantial route of exposure to arsenic, and it remains unknown whether it can provide a sufficient level of exposure to affect pulmonary function in inefficient metabolizers. Within 12,609 participants of HCHS/SOL, asthma diagnoses and spirometry-based measures of pulmonary function were assessed, and rice consumption was inferred from grain intake via a food frequency questionnaire. After stratifying by smoking history, the relationship between arsenic metabolism efficiency [percentages of inorganic arsenic (%iAs), monomethylarsenate (%MMA), and dimethylarsinate (%DMA) species in urine] and the measures of pulmonary function were estimated in a two-sample Mendelian randomization approach (genotype information from an Illumina HumanOmni2.5-8v1-1 array), focusing on participants with high inferred rice consumption. Among never-smoking high inferred consumers of rice (n = 1395), inefficient metabolism was associated with past asthma diagnosis and forced vital capacity below the lower limit of normal (LLN) (OR 1.40, p = 0.0212 and OR 1.42, p = 0.0072, respectively, for each percentage-point increase in %iAs; OR 1.26, p = 0.0240 and OR 1.24, p = 0.0193 for %MMA; OR 0.87, p = 0.0209 and OR 0.87, p = 0.0123 for the marker of efficient metabolism, %DMA). Among ever-smoking high inferred consumers of rice (n = 1127), inefficient metabolism was associated with peak expiratory flow below LLN (OR 1.54, p = 0.0108/percentage-point increase in %iAs, OR 1.37, p = 0.0097 for %MMA, and OR 0.83, p = 0.0093 for %DMA). Less efficient arsenic metabolism was associated with indicators of pulmonary dysfunction among those with high inferred rice consumption, suggesting that reductions in dietary arsenic could improve respiratory health.

scholarly journals Planning prompts to promote uptake of HIV services among men: a randomised trial in rural Uganda

2020 ◽  
Vol 5 (11) ◽  
pp. e003390
Author(s):  
Nolan M Kavanagh ◽  
Elisabeth M Schaffer ◽  
Alex Ndyabakira ◽  
Kara Marson ◽  
Diane V Havlir ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Community Health ◽  
Control Group ◽  
Health Campaign ◽  
Percentage Point Increase ◽  
Percentage Points ◽  
Point Increase ◽  
Cost Planning ◽  
Testing Uptake ◽  
The Impact

IntroductionInterventions informed by behavioural economics, such as planning prompts, have the potential to increase HIV testing at minimal or no cost. Planning prompts have not been previously evaluated for HIV testing uptake. We conducted a randomised clinical trial to evaluate the effectiveness of low-cost planning prompts to promote HIV testing among men.MethodsWe randomised adult men in rural Ugandan parishes to receive a calendar planning prompt that gave them the opportunity to make a plan to get tested for HIV at health campaigns held in their communities. Participants received either a calendar showing the dates when the community health campaign would be held (control group) or a calendar showing the dates and prompting them to select a date and time when they planned to attend (planning prompt group). Participants were not required to select a date and time or to share their selection with study staff. The primary outcome was HIV testing uptake at the community health campaign.ResultsAmong 2362 participants, 1796 (76%) participants tested for HIV. Men who received a planning prompt were 2.2 percentage points more likely to test than the control group, although the difference was not statistically significant (77.1% vs 74.9%; 95% CI –1.2 to 5.7 percentage points, p=0.20). The planning prompt was more effective among men enrolled ≤40 days before the campaigns (3.6 percentage-point increase in testing; 95% CI –2.9 to 10.1, p=0.27) than among men enrolled >40 days before the campaigns (1.8 percentage-point increase; 95% CI –2.3 to 5.8, p=0.39), although the effects within the subgroups were not significant.ConclusionThese findings suggest that planning prompts may be an effective behavioural intervention to promote HIV testing at minimal or no cost. Large-scale studies should further assess the impact and cost-effectiveness of such interventions.

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