L&M Policy Research, LLC, 1743 Connecticut Ave NW, Ste 200, Washington, DC 20009. Email:
Am J Manag Care. 2020 Mar 1;26(3):e70-e75. doi: 10.37765/ajmc.2020.42638.
To examine the effects of MD-Value in Prevention (MDVIP) enrollment on Medicare expenditures and utilization among fee-for-service (FFS) beneficiaries with diabetes over a 5-year period.
We obtained participating physician and beneficiary enrollment lists from MDVIP and Medicare FFS claims data through the Virtual Research Data Center to compare changes in outcomes, before and after enrollment dates, with those of nonenrolled beneficiaries receiving primary care in the same local market.
We employed propensity score matching to identify comparison beneficiaries similar in observed characteristics and preenrollment trends. Individual fixed effects were used to control for time-consistent differences between treatment and comparison populations.
We found that enrollment is statistically associated with reductions in outpatient expenditures, Medicare expenditures in year 5, emergency department (ED) utilization, and unplanned inpatient admissions, accompanied by significant increases in evaluation and management visits and expenditures. Total Medicare expenditures over the 5-year period, as well as all inpatient admissions, were not statistically different between the MDVIP and comparison groups.
Our finding of reduced unplanned inpatient admissions and ED utilization supports the previous findings regarding MDVIP enrollees. We did not find significant changes in overall third-party expenditures, although savings were estimated in year 5, the last year of observation, and may occur later. Our approach, however, strengthens controls for baseline characteristics of the population and uses a comparison population drawn from the same markets who do not experience the loss of their primary care physician at the time of enrollment.
在 5 年期间内，研究 MD-Value 在预防（MDVIP）参与对服务付费（FFS）糖尿病受益人的医疗保险支出和利用的影响。
我们从 MDVIP 和医疗保险 FFS 索赔数据中获得了参与医生和受益人的登记名单，通过虚拟研究数据中心将登记日期前后的结果变化与同一当地市场接受初级保健的未登记受益人的结果进行比较。
我们采用倾向评分匹配来识别具有相似观察特征和预先登记趋势的对照受益人群体。使用个体固定效应来控制治疗和对照人群之间时间一致的差异。
我们发现，登记与门诊支出、第 5 年的医疗保险支出、急诊部（ED）利用率和非计划住院入院的减少具有统计学相关性，同时评估和管理访问和支出显著增加。5 年内的总医疗保险支出以及所有住院入院均在 MDVIP 和对照组之间无统计学差异。
我们发现非计划住院入院和 ED 利用率减少的结果支持先前关于 MDVIP 参与者的发现。尽管在观察的最后一年即第 5 年估计有节省，但我们没有发现第三方支出的总体显著变化，并且可能会在以后发生。然而，我们的方法加强了对人群基线特征的控制，并使用了从相同市场抽取的不经历主要保健医生在登记时失去的对照人群。
