I am an ethnic minority gerontologist-health services researcher at the Department of Health Services, Policy, and Practice and the Center for Gerontology and Healthcare Research at Brown University. The purpose of this K01 proposal is to provide me with the additional training and research experience necessary to become an independent investigator studying health insurance decision-making among vulnerable seniors with Alzheimer?s disease and Related Dementias (ADRD). Since these individuals may have more difficulty making complex decisions, it is imperative that we better understand how they choose a Medicare Advantage (MA) plan and why they choose to disenroll. My training plan focuses on five interrelated aims to develop expertise in models and theory of decision-making among seniors with and without ADRD, behavioral economics and econometric methods, consumer choice in healthcare and policy environment, mixed-methods research, and design of decision-supportive interventions for older adults with and without ADRD. To achieve these goals, I have assembled a team of mentors and collaborators from a multi-disciplinary group of established researchers and practical research experience that addresses my training needs. The team is led by Amal Trivedi, MD., a health services researcher with experience in MA and the impact of benefit plan design on health services use and outcomes experienced by Medicare beneficiaries. Co-mentors and advisors include: Dr. Momotazur Rahman, an expert in the economics of aging and how patients? choice affect health outcomes; Dr. Renee Shield, an expert in conducting qualitative and mixed-methods research in different health care settings; Dr. Steven Sloman, an expert in decision-making; Dr. Gary Epstein-Lubow, a psychiatrist and an expert in ADRD and dementia care; and Dr. Vincent Mor, an expert in implementing and evaluating interventions and clinical trials. My training activities have been integrated with the following Specific Aims to understand the insurance decision-making processes among people with and without dementia: 1) To determine quality of choice of MA plans among vulnerable groups with and without dementia; 2) To analyze switching among vulnerable populations with different types of dementia enrolled in MA plans; 3) To qualitatively describe how seniors with and without dementia switch and disenroll from MA and how they make their next choice. Brown University offers an outstanding environment for scientific research in Gerontology and Health Services Research, and numerous opportunities for professional development. The faculty members leading this research are dedicated mentors committed to the success of trainees. This department has given me its strongest support for my continued training and research activities during the award period. At the K01 nears conclusion, I will be well-positioned to submit a competitive R01 during Year 4 that will propose an intervention to facilitate optimal decision making in various stages of ADRD and strategies for simplifying choices for health insurance and treatment-related decisions for older adults, and individuals with dementia.
The proposed research and career development plan is relevant to public health because it will yield important new insights to help vulnerable older adults to gain the tools and resources to select insurance options that best meet their informed preferences in the Medicare Advantage program. Despite the dramatic increase in enrollment of racial and ethnic minorities with low-income in Medicare Advantage plans, there is no information to guide older adults and policy makers regarding decision-making regarding plan choice and disenrollment. The findings of this K01 will positively impact several audiences, including 1) the Medicare program which needs evidence to optimize beneficiaries? choices in Medicare Advantage, and 2) vulnerable populations with and without cognitive impairment and their families who would benefit from choosing plans that maximize quality of care with lower out-of-pocket spending.
