Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2019 Oct;57(10):795-800. doi: 10.1097/MLR.0000000000001193.
A growing proportion of Medicare beneficiaries is covered by private insurers through Medicare Advantage, yet little is known about how these plans are structured in terms of relationships with physicians and implications for quality of care.
The objective of this study was to assess whether greater physician concentration of services across insurers was associated with higher quality in Medicare Advantage (MA), overall and particularly among MA insurers serving a high proportion of vulnerable enrollees.
A retrospective cohort design with regression analysis.
The primary dataset was 2014 MA encounter records submitted by insurers to the Centers for Medicare and Medicaid Services, covering 600,329 physicians across 119 insurers. These data were merged with Centers for Medicare and Medicaid Services data on MA contract quality rating as well as physician characteristics in the Medicare Data on Provider Practice and Specialty file.
Two measures were generated to capture the concentration of physician services across insurers: the percentage of a physician's Medicare services which was through MA (MA penetration); and the percentage of a physician's MA services with a specific insurer (insurer share of MA services).
Greater MA penetration and insurer share of MA services were each associated with higher MA plan quality. The relationship between insurer share and quality was stronger in contracts with a relatively high percentage of disabled enrollees.
Greater physician concentration of services across MA insurers was associated with a higher quality of care overall and especially among vulnerable enrollees.
越来越多的医疗保险受益人通过医疗保险优势计划（Medicare Advantage）由私人保险公司承保，但对于这些计划在与医生的关系以及对护理质量的影响方面的结构却知之甚少。
本研究旨在评估保险公司之间服务的医生集中程度是否与医疗保险优势（Medicare Advantage，MA）的更高质量相关，特别是在为大量弱势参保者提供服务的 MA 保险公司中。
回顾性队列设计和回归分析。
主要数据集是 2014 年保险公司向医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）提交的 MA 就诊记录，涵盖了 119 家保险公司的 600,329 名医生。这些数据与医疗保险和医疗补助服务中心关于 MA 合同质量评级的数据以及医疗保险提供者实践和专业数据文件中的医生特征进行了合并。
生成了两个衡量指标来捕捉保险公司之间医生服务的集中程度：医生的医疗保险服务中通过 MA 提供的比例（MA 渗透率）；以及医生的 MA 服务中与特定保险公司的比例（MA 服务的保险公司份额）。
更高的 MA 渗透率和 MA 服务的保险公司份额都与更高的 MA 计划质量相关。保险公司份额与质量之间的关系在残疾参保者比例相对较高的合同中更强。
MA 保险公司之间服务的医生集中程度越高，整体护理质量越高，特别是在弱势参保者中。
