Budgetary issues have intensified the focus on improving efficiency in publicly funded health programs. Yet Medicare and Medicaid insure some of the most ill or disabled patients, who are also some of the most expensive. Proposals to address costs create incentives to increase care coordination and accountability for the continuum of care. Realizing spending reductions in this population, however, needs to be balanced with assuring quality for a group at high risk for mortality, functional loss, and decline in quality of life. The overarching goal of this project is to study how fragmentation of care, and the reverse, increased integration, vary with cost and quality of care for high need beneficiaries, including patients dually eligible for Medicare and Medicaid. Efficient care for high need patients may require a broad network that includes multiple physician specialties, acute care hospital, and other types of inpatient care (psychiatric, long term acute hospital or nursing home). In previous work, we have developed an actionable unit - the physician-hospital network - which links Medicare beneficiaries to the specific physicians and hospitals that deliver the majority of their care. We seek to broaden this approach with respect to high need patients using observational cohort methods. We will use national Medicare, Medicaid and Minimum Data Set data to address major gaps in the literature.
In Aim 1, we will define networks of healthcare providers for high need patients, and how patients, care, and spending are distributed within and across these networks.
In Aim 2, we will test how cost and quality of care for high need patients vary with system (i.e. provider network and region) characteristics. And in Aim 3, we will take advantage of changes in the marketplace to study how cost and quality measures change as health systems formally integrate. The long-term impact of this work will be to provide rigorous information about who can reasonably be held accountable for the care of high need patients and identify the points of leverage for improving outcomes.

Public Health Relevance

States, health plans and the Centers for Medicare and Medicaid Services (CMS) are already focusing on the high need, high cost population. But they lack a robust research base on which to make wise spending decisions. The importance of our proposed body of work is to help stakeholders design and prioritize their efforts to attain cost reductions and protect against loss of access while maintaining or even improving quality for this high risk population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
2P01AG019783-11
Application #
8461338
Study Section
Special Emphasis Panel (ZAG1-ZIJ-1 (01))
Project Start
Project End
Budget Start
2012-12-01
Budget End
2013-11-30
Support Year
11
Fiscal Year
2013
Total Cost
$218,326
Indirect Cost
$82,860
Name
Dartmouth College
Department
Type
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A (2018) Outcomes of Elective Cerebral Aneurysm Treatment Performed by Attending Neurosurgeons after Night Work. Neurosurgery 82:329-334
Jeffery, Molly Moore; Hooten, W Michael; Henk, Henry J et al. (2018) Trends in opioid use in commercially insured and Medicare Advantage populations in 2007-16: retrospective cohort study. BMJ 362:k2833
Jeffery, Molly Moore; Hooten, W Michael; Hess, Erik P et al. (2018) Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use. Ann Emerg Med 71:326-336.e19
Finkelstein, Amy; Ji, Yunan; Mahoney, Neale et al. (2018) Mandatory Medicare Bundled Payment Program for Lower Extremity Joint Replacement and Discharge to Institutional Postacute Care: Interim Analysis of the First Year of a 5-Year Randomized Trial. JAMA 320:892-900
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A (2018) Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State. Br J Neurosurg 32:13-17
Mainor, Alexander J; Morden, Nancy E; Smith, Jeremy et al. (2018) ICD-10 Coding Will Challenge Researchers: Caution and Collaboration may Reduce Measurement Error and Improve Comparability Over Time. Med Care :
Norton, Edward C; Li, Jun; Das, Anup et al. (2018) Moneyball in Medicare. J Health Econ 61:259-273
Moen, Erika L; Kapadia, Nirav S; O'Malley, A James et al. (2018) Evaluating breast cancer care coordination at a rural National Cancer Institute Comprehensive Cancer Center using network analysis and geospatial methods. Cancer Epidemiol Biomarkers Prev :
Austin, Andrea M; Bynum, Julie P W; Maust, Donovan T et al. (2018) Long-Term Implications Of A Short-Term Policy: Redacting Substance Abuse Data. Health Aff (Millwood) 37:975-979
Likosky, Donald S; Sukul, Devraj; Seth, Milan et al. (2018) Association Between Medicaid Expansion and Cardiovascular Interventions in Michigan. J Am Coll Cardiol 71:1050-1051

Showing the most recent 10 out of 263 publications