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1.
J Manag Care Spec Pharm ; 30(8): 782-791, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39088333

RESUMEN

BACKGROUND: The appointment-based model (ABM) is a pharmacy service to improve medication-related health outcomes. ABM involves medication synchronization and medication review, plus other services such as medication reconciliation, medication therapy management, vaccine administration, and multimedication packaging. ABM can improve medication adherence, but the economic impact is unknown. OBJECTIVE: To assess the effect of a national pharmacy chain's ABM program for Medicare Advantage beneficiaries on total cost of care (TCOC). METHODS: This study analyzed administrative claims data from April 7, 2017, through February 29, 2020, for Medicare Advantage beneficiaries with Part D using a propensity score-matched cohort design. The national pharmacy chain provided a list of ABM participants. Eligibility criteria for the ABM and control (non-ABM) groups included age 65 years or older on the index date (initial participation, ABM; random fill date, control) and continuous enrollment from at least 6 months pre-index (baseline) date through at least 6 months post-index (follow-up) date. Medical inflation-adjusted (2020) TCOC was calculated as the sum of all health care spending from Medicare Advantage beneficiaries with Part D plan and patient paid amounts, standardized to per patient per month (PPPM), during the follow-up period. Secondary outcomes included medication adherence calculated across prevalent maintenance therapeutic classes using proportion of days covered (PDC). RESULTS: Each group contained 5,225 patients with balanced characteristics after matching: 64% female, 73% White, mean age 75 years, mean Quan-Charlson comorbidity index score 0.9, and hypertension and dyslipidemia, each >65%. Median baseline all-cause PPPM health care costs in the ABM and control groups, respectively, were $517 and $548 ($221 and $234 medical, $135 and $164 pharmacy). Baseline PDC of at least 80% was 83% in the ABM group and, similarly, 84% in the control group. The mean (SD) follow-up was 604 (155) days for the ABM group and 598 (151) days for the control group. During the follow-up period, the median PPPM TCOC for the ABM group was $656 and was $723 for the control group (P = 0.011). Median pharmacy costs were also significantly less in the ABM group ($161 vs $193, P < 0.001), whereas median medical costs were $328 in the ABM group and $358 among controls (P = 0.254). More patients in the ABM group were adherent during follow-up, with 84% achieving PDC of at least 80% vs 82% among controls (P = 0.009). CONCLUSIONS: The ABM program was associated with significantly lower follow-up median total costs (medical and pharmacy), driven primarily by pharmacy costs. More patients were adherent in the ABM program. Payers and pharmacies can use this evidence to assess ABM programs for their members.


Asunto(s)
Costos de la Atención en Salud , Medicare Part C , Cumplimiento de la Medicación , Humanos , Estados Unidos , Anciano , Femenino , Masculino , Medicare Part C/economía , Anciano de 80 o más Años , Costos de la Atención en Salud/estadística & datos numéricos , Citas y Horarios , Servicios Farmacéuticos/economía , Administración del Tratamiento Farmacológico/economía , Medicare Part D/economía , Estudios de Cohortes
2.
J Am Board Fam Med ; 37(3): 494-496, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39142865

RESUMEN

The Medicare Advantage (MA) Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. Recent investigations conducted by the United States Senate Committee on Finance and Centers for Medicare & Medicaid Services (CMS) have uncovered marketing practices of MA insurance agents that "were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision." These findings come at a time in which MA programs are under investigation for denials of prior authorization requests that fall within Medicare guidelines for covered health services. In this Commentary we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.


Asunto(s)
Medicare Part C , Estados Unidos , Medicare Part C/estadística & datos numéricos , Medicare Part C/economía , Humanos , Comercialización de los Servicios de Salud , Centers for Medicare and Medicaid Services, U.S.
3.
JAMA Netw Open ; 7(7): e2421102, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38990572

RESUMEN

Importance: The Centers for Medicare & Medicaid Services Innovation Center Independence at Home (IAH) demonstration, a test of home-based primary care operating in a value-based shared-savings payment model, ended December 2023 after a decade of consistently showing savings to Medicare. It is important to assess whether high-need, IAH-qualified beneficiaries continue to pose a growing challenge to traditional Medicare (TM) or if Medicare Advantage (MA), with programmatic features favorable to caring for this subset of the general Medicare population, can disproportionately provide such care. Objective: To examine the size and share of IAH-qualified beneficiaries in TM and MA. Design, Setting, and Participants: This cohort study used all Medicare claims data and MA encounter data for 2014 and 2021. IAH qualifying criteria were applied to the TM populations enrolled in Parts A and B in 2014 and 2021, and to MA enrollees in 2021. Growth in the number of IAH-qualified TM beneficiaries from 2014 to 2021 was calculated, and the proportions and numbers of IAH-qualified enrollees in the total 2021 TM and MA populations were compared. Data were analyzed between April and June 2023. Main Outcomes and Measures: The number and share of beneficiaries meeting IAH criteria in TM and MA; the share of TM spending among IAH-qualified beneficiaries. Results: Among 64 million Medicare beneficiaries in 2021, there were 30.55 million beneficiaries in TM with Parts A and B coverage, down from 33.82 million in 2014. The number of IAH-qualified beneficiaries in TM grew 51%, from 2.16 million to 3.27 million, while their proportionate share in TM grew 67% from 6.4% to 10.7% of TM between 2014 and 2021. IAH-qualified beneficiaries represented $155 billion in 2021 Medicare Parts A and B spending, 44% of all TM spending, up from 29% of total spending in 2014. In 2021, 2.15 million IAH-qualified beneficiaries represented 8.0% of Medicare Advantage enrollees. Combining TM and MA, 5.42 million IAH-qualified beneficiaries represented 9.3% of all Medicare beneficiaries, with 3.27 million (60.3%) being insured by TM. Conclusions and Relevance: In this cohort study of IAH-qualified Medicare beneficiaries, the share of IAH-qualified beneficiaries in TM grew between 2014 and 2021, with 60% of Medicare high-need beneficiaries accounting for 44% of TM spending. The Centers for Medicare & Medicaid Services should continue to operate value-based programs like IAH that are specifically designed for these high-needs individuals.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Medicare , Humanos , Estados Unidos , Masculino , Femenino , Anciano , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/economía , Medicare/estadística & datos numéricos , Anciano de 80 o más Años , Estudios de Cohortes , Prevalencia , Atención Primaria de Salud/estadística & datos numéricos , Atención Primaria de Salud/economía , Medicare Part C/estadística & datos numéricos , Medicare Part C/economía
4.
JAMA Intern Med ; 184(8): 865-866, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38857031

RESUMEN

This Viewpoint makes the case for eliminating Medicare Advantage and doubling down on Traditional Medicare.


Asunto(s)
Medicare Part C , Estados Unidos , Humanos , Medicare Part C/economía , Costos de la Atención en Salud/estadística & datos numéricos , Anciano , Gastos en Salud/estadística & datos numéricos
6.
Ann Intern Med ; 177(7): 882-891, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38914004

RESUMEN

BACKGROUND: Compared with traditional Medicare (TM), Medicare Advantage (MA) plans typically offer supplemental benefits and lower copayments for in-network services and must include an out-of-pocket spending limit. OBJECTIVE: To examine whether the financial burden of care decreased for persons switching from TM to MA (TM-to-MA switchers) relative to those remaining in TM (TM stayers). DESIGN: Retrospective longitudinal cohort study comparing changes in financial outcomes between TM-to-MA switchers and TM stayers. SETTING: Population-based. PARTICIPANTS: 7054 TM stayers and 1544 TM-to-MA switchers from the Medical Expenditure Panel Survey, 2014 to 2021. MEASUREMENTS: Individual health care costs (out-of-pocket spending and cost sharing), financial burden (high and catastrophic), and subjective financial hardship (difficulty paying medical bills, paying medical bills over time, and inability to pay medical bills). RESULTS: Compared with TM stayers, TM-to-MA switchers had small differences in out-of-pocket spending ($168 [95% CI, -$133 to $469]) and proportions of total health expenses paid out of pocket (cost sharing) (0.2 percentage point [CI, -1.3 to 1.7 percentage points]), families with out-of-pocket spending greater than 20% of their income (high financial burden) (0.3 percentage point [CI, -2.5 to 3.0 percentage points]), families reporting out-of-pocket spending greater than 40% of their income (catastrophic financial burden) (0.7 percentage point [CI, -0.1 to 1.6 percentage points]), families reporting paying medical bills over time (-0.2 percentage point [CI, -1.7 to 1.4 percentage points]), families having problems paying medical bills (-0.4 percentage point [CI, -2.7 to 1.8 percentage points]), and families reporting being unable to pay medical bills (0.4 percentage point [CI, -1.3 to 2.0 percentage points]). LIMITATION: Inability to account for all medical care and cost needs and variations across MA plans, small baseline differences in out-of-pocket spending, and potential residual confounding. CONCLUSION: Differences in financial outcomes between beneficiaries who switched from TM to MA and those who stayed with TM were small. Differences in financial burden ranged across outcomes and did not have a consistent pattern. PRIMARY FUNDING SOURCE: The National Research Foundation of Korea.


Asunto(s)
Gastos en Salud , Medicare Part C , Humanos , Estados Unidos , Medicare Part C/economía , Estudios Retrospectivos , Gastos en Salud/estadística & datos numéricos , Masculino , Femenino , Anciano , Estudios Longitudinales , Seguro de Costos Compartidos , Costo de Enfermedad
7.
JAMA Health Forum ; 5(5): e241270, 2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38819797

RESUMEN

Importance: In a randomized clinical trial, treatment guided by tumor-informed circulating tumor (ct)DNA testing reduced adjuvant chemotherapy use without compromising recurrence-free survival in patients with stage II colon cancer. The potential effects of adopting ctDNA testing into routine patient care is unknown. Objective: To compare the total cost of patient care scenarios with and without the adoption of ctDNA testing. Design, Setting, and Participants: This budget impact analysis was conducted from the perspectives of US commercial health and Medicare Advantage payers. A decision-analytical model was populated with age-specific incidence of colon cancer, use of adjuvant chemotherapy, and use of single-agent or multiagent regimens. Total cost was estimated with the costs of ctDNA testing, drug acquisition, administration, surveillance, and adverse events. The analysis was conducted from September 2023 to January 2024. Exposures: The adoption of ctDNA testing. Main Outcomes and Measures: The incremental cost in the first year following the adoption of ctDNA testing, where testing will affect patient treatment and costs. Results: In hypothetical plans with 1 million individuals covered, 35 commercial health plan members and 102 Medicare Advantage members aged 75 years and younger were eligible for ctDNA testing. In the base case with a 50% adoption rate, total cost savings were $221 684 (equivalent to $0.02 per member per month [PMPM]) for a commercial payer and $116 720 (equivalent to $0.01 PMPM) for a Medicare Advantage payer. Cost savings were robust to variations in assumptions of all parameters in the commercial population but sensitive to variations in assumptions of adjuvant chemotherapy use rates in the Medicare Advantage population. The number needed to test to avoid 1 patient receiving adjuvant chemotherapy was 4 in the commercial population and 10 in the Medicare Advantage population. The budget-neutral cost for ctDNA testing was $16 202 for a commercial payer and $5793 for a Medicare Advantage payer. Conclusions and Relevance: Use of tumor-informed ctDNA testing to guide adjuvant chemotherapy in postsurgery patients with stage II colon cancer was projected to result in cost savings for both commercial and Medicare Advantage payers. Adoption of ctDNA testing is therefore advantageous from a budgetary perspective.


Asunto(s)
ADN Tumoral Circulante , Neoplasias del Colon , Medicare Part C , Humanos , Neoplasias del Colon/economía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/sangre , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/genética , Estados Unidos , Medicare Part C/economía , ADN Tumoral Circulante/sangre , ADN Tumoral Circulante/genética , Anciano , Femenino , Masculino , Presupuestos , Persona de Mediana Edad , Análisis Costo-Beneficio
8.
Am J Manag Care ; 30(5): 210-217, 2024 05.
Artículo en Inglés | MEDLINE | ID: mdl-38748928

RESUMEN

OBJECTIVE: To examine the association between missed CMS Star Ratings quality measures for medication adherence over 3 years for diabetes, hypertension, and hyperlipidemia medications (9 measures) and health care utilization and relative costs. STUDY DESIGN: Retrospective cohort study. METHODS: The study examined eligible patients who qualified for the diabetes, statin, and renin-angiotensin system antagonist medication adherence measures in 2018, 2019, and 2020 and were continuously enrolled in a Medicare Advantage prescription drug plan from 2017 through 2021. A total of 103,900 patients were divided into 4 groups based on the number of adherence measures missed (3 medication classes over 3 years): (1) missed 0 measures, (2) missed 1 measure, (3) missed 2 or 3 measures, and (4) missed 4 or more measures. To achieve a quality measure, patients had to meet the Pharmacy Quality Alliance 80% threshold of proportion of days covered during the calendar year. RESULTS: The mean age of the cohort was 71.1 years, and 49.9% were female. Compared with patients who missed 0 of 9 adherence measures, those who missed 1 measure, 2 or 3 measures, and 4 or more measures experienced 12% to 26%, 22% to 42%, and 24% to 50% increased risks, respectively, of all-cause and diabetes-related inpatient stays and all-cause and diabetes-related emergency department visits (all  P  values < .01). Additionally, patients who missed 1, 2 or 3, and 4 or more adherence measures experienced 14%, 19%, and 20% higher monthly medical costs, respectively. CONCLUSIONS: Missing Star Ratings quality measures for medication adherence was associated with an increased likelihood of health care resource utilization and increased costs for patients taking medications to treat diabetes, hypertension, and hyperlipidemia.


Asunto(s)
Diabetes Mellitus , Hiperlipidemias , Hipertensión , Cumplimiento de la Medicación , Aceptación de la Atención de Salud , Humanos , Femenino , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Estudios Retrospectivos , Anciano , Estados Unidos , Hipertensión/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/economía , Hiperlipidemias/tratamiento farmacológico , Aceptación de la Atención de Salud/estadística & datos numéricos , Medicare Part C/economía , Medicare Part C/estadística & datos numéricos , Anciano de 80 o más Años , Persona de Mediana Edad , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/economía , Antihipertensivos/uso terapéutico , Antihipertensivos/economía , Indicadores de Calidad de la Atención de Salud
9.
Am J Manag Care ; 30(5): 218-223, 2024 05.
Artículo en Inglés | MEDLINE | ID: mdl-38748929

RESUMEN

OBJECTIVES: Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare (TM). We examined changes in Medicare supplemental insurance coverage in the context of MA growth. STUDY DESIGN: Repeated cross-sectional analysis of the Medicare Current Beneficiary Survey from 2005 to 2019. METHODS: We determined whether Medicare beneficiaries 65 years and older were enrolled in MA (without Medicaid), TM without supplemental coverage, TM with employer-sponsored supplemental coverage, TM with Medigap, or Medicaid (in TM or MA). RESULTS: From 2005 to 2019, beneficiaries with TM and supplemental insurance provided by their former (or current) employer declined by approximately half (31.8% to 15.5%) while the share in MA (without Medicaid) more than doubled (13.4% to 35.1%). The decline in supplemental employer-sponsored insurance use was greater for White and for higher-income beneficiaries. Over the same period, beneficiaries in TM without supplemental coverage declined by more than a quarter (13.9% to 10.1%). This decline was largest for Black, Hispanic, and lower-income beneficiaries. CONCLUSIONS: The rapid rise in MA enrollment from 2005 to 2019 was accompanied by substantial changes in supplemental insurance with TM. Our results emphasize the interconnectedness of different insurance choices made by Medicare beneficiaries.


Asunto(s)
Medicare Part C , Humanos , Estados Unidos , Medicare Part C/estadística & datos numéricos , Medicare Part C/economía , Anciano , Estudios Transversales , Masculino , Femenino , Medicare/estadística & datos numéricos , Medicare/economía , Cobertura del Seguro/estadística & datos numéricos , Anciano de 80 o más Años , Seguro de Costos Compartidos/estadística & datos numéricos , Seguro Adicional/estadística & datos numéricos
10.
Health Aff (Millwood) ; 43(5): 614-622, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38709969

RESUMEN

With Medicare Advantage (MA) enrollment surpassing 50 percent of Medicare beneficiaries, accurate risk-adjusted plan payment rates are essential. However, artificially exaggerated coding intensity, where plans seek to enhance measured health risk through the addition or inflation of diagnoses, may threaten payment rate integrity. One factor that may play a role in escalating coding intensity is health risk assessments (HRAs)-typically in-home reviews of enrollees' health status-that enable plans to capture information about their enrollees. In this study, we evaluated the impact of HRAs on Hierarchical Condition Categories (HCC) risk scores, variation in this impact across contracts, and the aggregate payment impact of HRAs, using 2019 MA encounter data. We found that 44.4 percent of MA beneficiaries had at least one HRA. Among those with at least one HRA, HCC scores increased by 12.8 percent, on average, as a result of HRAs. More than one in five enrollees had at least one additional HRA-captured diagnosis, which raised their HCC score. Potential scenarios restricting the risk-score impact of HRAs correspond with $4.5-$12.3 billion in reduced Medicare spending in 2020. Addressing increased coding intensity due to HRAs will improve the value of Medicare spending and ensure appropriate payment in the MA program.


Asunto(s)
Medicare Part C , Ajuste de Riesgo , Humanos , Estados Unidos , Medicare Part C/economía , Medición de Riesgo , Anciano , Masculino , Femenino , Gastos en Salud/estadística & datos numéricos , Estado de Salud , Anciano de 80 o más Años
11.
J Manag Care Spec Pharm ; 30(6): 560-571, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38591754

RESUMEN

BACKGROUND: Antipsychotic medications are the mainstay of schizophrenia therapy but may need to be changed over the course of a patient's illness to achieve the desired therapeutic goals or minimize medication side effects. Investigations of real-world treatment patterns and economic consequences associated with antipsychotic changes, including switching, are limited. OBJECTIVE: To describe treatment patterns among patients with schizophrenia who initiated oral antipsychotic medication (OAM) monotherapy and assess switching-related health care resource utilization (HCRU) and costs in US Medicare Advantage and commercially insured patients. METHODS: Adults with at least 2 claims with a schizophrenia diagnosis who initiated (or reinitiated after ≥6 months) OAM monotherapy between January 1, 2015, and June 30, 2021, were identified in the Optum Research Database. A claims-based algorithm using timing of therapies and treatment gaps identified medication changes, specifically OAM monotherapy switches, among OAM initiators over a period of up to 7 years. Patients who switched from their initial OAM monotherapy to a second OAM monotherapy (initial OAM switchers) were matched based on clinical and demographic characteristics to OAM initiators who had not switched OAMs; switch-related HCRU and costs (incurred up to 3 months before and 3 months after the initial OAM switch) were compared between matched initial OAM switchers and nonswitchers. RESULTS: Among 6,425 OAM monotherapy initiators, 1,505 (23.4%) had at least 1 OAM monotherapy switch at any time during follow-up, with a mean (SD) time to first switch of 209 (333) days (median, 67 days), a rate of 0.65 switches per person-year of follow-up, and 56% of first switches occurring within 3 months of OAM initiation. Of all OAM initiators, 947 (14.7%) were initial OAM switchers. Compared with 865 matched nonswitchers, 865 initial OAM switchers had greater mean counts of all-cause medical visits and greater mean counts of schizophrenia-related emergency and inpatient visits and longer inpatient stays per patient per month. Mean (SD) total schizophrenia-related costs per patient per month were $1,252 ($2,602) for switchers compared with $402 ($2,027) for nonswitchers (P < 0.001). CONCLUSIONS: Changes to antipsychotic therapy in our sample of patients with schizophrenia were common, with nearly one-fourth switching OAMs, the majority within the first 3 months of therapy. Initial OAM switchers experienced greater HCRU and costs than nonswitchers. These findings highlight the importance of initiating OAM monotherapy that effectively maintains symptom control and minimizes tolerability issues, which would limit the need to switch OAMs and therefore prevent excess HCRU and treatment costs.


Asunto(s)
Antipsicóticos , Revisión de Utilización de Seguros , Esquizofrenia , Humanos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/economía , Antipsicóticos/economía , Antipsicóticos/uso terapéutico , Antipsicóticos/administración & dosificación , Femenino , Masculino , Estados Unidos , Adulto , Persona de Mediana Edad , Administración Oral , Estudios Retrospectivos , Sustitución de Medicamentos/economía , Costos de la Atención en Salud/estadística & datos numéricos , Medicare Part C/economía , Adulto Joven , Anciano , Costos de los Medicamentos
12.
Health Serv Res ; 59(3): e14298, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38450687

RESUMEN

OBJECTIVE: To examine the relationship between growth in Medicare Advantage (MA) enrollment and changes in finances at skilled nursing facilities (SNFs). DATA SOURCES: Medicare SNF cost reports, LTCFocus.org data, and county MA penetration rates. STUDY DESIGN: We used ordinary least squares regression with SNF and year fixed effects. Our primary outcomes were SNF revenues, expenses, profits, and occupancy. Our primary independent variable was the yearly county Medicare Advantage penetration. DATA COLLECTION/EXTRACTION: We linked facility-year data from 2012 to 2019 obtained from cost reports and LTCFocus.org to county-year MA penetration. PRINCIPAL FINDINGS: A 10 percentage point increase in county MA enrollment was associated with a $213,883.89 (95% Confidence Interval [CI]: -296,869.08, -130,898.71) decrease in revenue, a $132,456.19 (95% CI: -203,852.28, -61,060.10) decrease in expenses, and a 0.59 percentage point (95% CI: -0.97, -0.21) decrease in profit margin. A 10 percentage point increase in county MA enrollment was associated with a decline (-318.93; 95% CI: -468.84, -169.02) in the number of resident-days (a measure of occupancy) as well as a decline in the revenue per resident day ($4.50; 95% CI: -6.81, -2.20), potentially because of lower prices in MA. There was also a decline in expenses per patient day (-2.35; 95% CI: -4.76, 0.05), though this was only statistically significant at the 10% level. While increased MA enrollment was associated with a substantial decline in the number of Medicare resident days (487.53; 95% CI: -588.70, -386.37), this was partially offset by an increase in other payer (e.g., private pay) resident days (285.91; 95% CI: 128.18, 443.63). Increased MA enrollment was not associated with changes in the number of Medicaid resident days or a decrease in staffing per resident day. CONCLUSION: SNFs in counties with more MA growth had substantially greater relative declines in revenue, expenses, and profit margins. The continued growth of MA may result in significant changes in the SNF industry.


Asunto(s)
Medicare Part C , Instituciones de Cuidados Especializados de Enfermería , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Estados Unidos , Humanos , Medicare Part C/economía , Medicare Part C/estadística & datos numéricos , Anciano
15.
Am J Geriatr Psychiatry ; 32(6): 739-750, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38267358

RESUMEN

OBJECTIVE: We examined the differences in health care spending and utilization, and financial hardship between Traditional Medicare (TM) and Medicare Advantage (MA) enrollees with mental health symptoms. DESIGN: Cross-sectional study. PARTICIPANTS: We identified Medicare beneficiaries with mental health symptoms using the Patient Health Questionnaire-2 and the Kessler-6 Psychological Distress Scale in the 2015-2021 Medical Expenditure Panel Survey. MEASUREMENTS: Outcomes included health care spending and utilization (both general and mental health services), and financial hardship. The primary independent variable was MA enrollment. RESULTS: MA enrollees with mental health symptoms were 2.3 percentage points (95% CI: -3.4, -1.2; relative difference: 16.1%) less likely to have specialty mental health visits than TM enrollees with mental health symptoms. There were no significant differences in total health care spending, but annual out-of-pocket spending was $292 (95% CI: 152-432; 18.2%) higher among MA enrollees with mental health symptoms than TM enrollees with mental health symptoms. Additionally, MA enrollees with mental health symptoms were 5.0 (95% CI: 2.9-7.2; 22.3%) and 2.5 percentage points (95% CI: 0.8-4.2; 20.9%) more likely to have difficulty paying medical bills over time and to experience high financial burden than TM enrollees with mental health symptoms. CONCLUSION: Our findings suggest that MA enrollees with mental health symptoms were more likely to experience limited access to mental health services and high financial hardship compared to TM enrollees with mental health symptoms. There is a need to develop policies aimed at improving access to mental health services while reducing financial burden for MA enrollees.


Asunto(s)
Estrés Financiero , Gastos en Salud , Medicare Part C , Medicare , Humanos , Estados Unidos/epidemiología , Masculino , Femenino , Anciano , Gastos en Salud/estadística & datos numéricos , Estudios Transversales , Medicare/estadística & datos numéricos , Medicare/economía , Medicare Part C/economía , Medicare Part C/estadística & datos numéricos , Estrés Financiero/epidemiología , Servicios de Salud Mental/estadística & datos numéricos , Servicios de Salud Mental/economía , Anciano de 80 o más Años , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos
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