医疗保险与医疗补助双重人群的融合机遇:北卡罗来纳州现状分析

Q2 Medicine
Salama S. Freed, Nicole Frascino, Kelley A Jones, Abhigya Giri, Lucas Stewart, Keren Hendel, Amy G. Clark, Courtney Van Houtven, Aparna Higgins, B. Kaufman
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引用次数: 0

摘要

北卡罗来纳州医疗补助计划正在向以价值为基础的护理模式转型。这种转变需要考虑能为五分之一同时参加医疗保险的北卡罗来纳州医疗补助受益人提供最佳服务的模式。医疗保险和医疗补助计划在管理、筹资和护理方面缺乏整合,可能会导致不理想的健康结果和护理体验。要整合医疗保险和医疗补助计划以改善对双重参保者的护理,需要了解北卡罗来纳州的人口统计、资格和参保趋势,以及这些人的医疗需求。我们对 2019 年北卡罗来纳州医疗补助管理注册数据以及 2015-2020 年医疗保险和医疗补助公共使用档案进行了横截面分析。北卡罗来纳州近一半的全福利双重资格 (FBDE) 人口因残疾而有资格参加医疗保险。约三分之一的全福利双符合资格人口在 2019 年的某个时间点失去了全额医疗补助福利;其中 65% 的人年龄在 65 岁以下。大多数 FBDE 受益人参加了医疗补助收费服务,3.5% 的人参加了社区替代计划 (CAP) 减免,2% 的人参加了针对行为健康或智力和发育障碍 (BH/IDD) 或创伤性脑损伤 (TBI) 受益人的医疗补助减免,1% 的人参加了老年人全包护理计划 (PACE)。加入联邦医疗保险双重特殊需求计划(D-SNPs)的人数从 2015 年占 FBDE 人口的 7.3% 增加到 2021 年的 32.5%。这项针对北卡罗来纳州双职工的描述性横截面评估可能无法推广到其他时间段和环境中。医疗保险与医疗补助的整合为提高双重资格受益人的护理价值提供了机会,并与北卡罗来纳州医疗补助转型的目标相一致。利用现有基础设施的整合战略可最大限度地减少对受益人服务的干扰,并减轻不稳定注册的影响,特别是对工作年龄的成年人和残疾受益人的影响。双重资格人群的多样性要求制定一项旨在改善不同种族、残疾、资格、地域和医疗保健需求的健康公平性的战略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis
NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files. Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts. Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.
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来源期刊
North Carolina Medical Journal
North Carolina Medical Journal Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
121
期刊介绍: NCMJ, the North Carolina Medical Journal, is meant to be read by everyone with an interest in improving the health of North Carolinians. We seek to make the Journal a sounding board for new ideas, new approaches, and new policies that will deliver high quality health care, support healthy choices, and maintain a healthy environment in our state.
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