Aging, Disability, and Long-Term Care Program, RTI International, Research Triangle Park, NC, USA.
Health Policy Center, Urban Institute, Washington, DC, USA.
J Aging Soc Policy. 2020 Jan-Feb;32(1):31-54. doi: 10.1080/08959420.2018.1485396. Epub 2018 Jul 6.
Individuals dually eligible for Medicare and Medicaid often receive fragmented and inefficient care. Using Minnesota fee-for-service claims, managed care encounters, and enrollment data for 2010-2012, we estimated the likely impact of Minnesota Senior Health Option (MSHO)-seen as the first statewide fully integrated Medicare-Medicaid model-on health care and long-term services and supports use, relative to Minnesota Senior Care Plus (MSC+), a Medicaid-only managed care plan with Medicare fee for service. Estimates suggest that MSHO enrollees had significantly higher use of primary care and, potentially, of community-based services, combined with lower use of hospital-based care than similar MSC+ enrollees. Adopting fully integrated care models like MSHO may have merit in other states.
同时符合医疗保险和医疗补助资格的个人往往接受的是零散且效率低下的医疗服务。我们使用明尼苏达州的按服务收费索赔、管理式医疗遭遇和 2010-2012 年的参保数据，评估了明尼苏达州老年人健康选择（MSHO）——被视为首个全州范围内完全整合的医疗保险-医疗补助模式——对医疗保健和长期服务与支持使用的可能影响，相对于仅提供医疗补助管理式医疗计划的明尼苏达州老年人护理加（MSC+）。估计表明，MSHO 参保者的初级保健服务利用率明显更高，并且可能使用了更多的社区服务，同时比类似的 MSC+参保者的住院治疗利用率更低。在其他州采用完全整合的护理模式，如 MSHO，可能具有一定的优势。
