Haye Sidra, Jacobson Mireille, Joyce Geoffrey, Zissimopoulos Julie M
Sidra Haye, University of Southern California, Los Angeles, California.
Mireille Jacobson, University of Southern California.
Health Aff (Millwood). 2025 Jan;44(1):81-89. doi: 10.1377/hlthaff.2024.00723.
In 2020, the Centers for Medicare and Medicaid Services reintroduced Alzheimer's disease and related dementias to its risk-adjustment payment model for Medicare Advantage (MA) plans. Using 2017-20 data for 100 percent of community-dwelling beneficiaries enrolled in Medicare, we evaluated how the reintroduction of dementia to the risk-adjustment model affected rates of new (incident) dementia diagnoses among beneficiaries enrolled in MA relative to those enrolled in traditional Medicare. In response to the payment change, annual incident dementia diagnosis rates in MA increased by 11.5 percent relative to traditional Medicare. This increase was concentrated among beneficiaries who were more likely to have undiagnosed dementia-specifically, beneficiaries who were Hispanic or Black, were ages eighty-five and older, or were dually eligible for Medicaid or received a Part D low-income subsidy. Only a third of the increase came through chart reviews. Financial incentives to detect dementia increased dementia diagnoses, particularly among beneficiaries at high risk for dementia and undetected dementia, but questions remain about potential overdiagnosis or upcoding.
2020年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）将阿尔茨海默病及相关痴呆症重新纳入其针对医疗保险优势（MA）计划的风险调整支付模型。利用2017 - 2020年100%参加医疗保险的社区居住受益人的数据，我们评估了痴呆症风险调整模型的重新引入对参加MA计划的受益人相对于参加传统医疗保险的受益人中新增（发病）痴呆症诊断率的影响。作为对支付变化的回应，MA计划中每年的痴呆症发病诊断率相对于传统医疗保险提高了11.5%。这种增加集中在更有可能患有未确诊痴呆症的受益人中——具体而言，是西班牙裔或黑人、年龄在85岁及以上、同时符合医疗补助资格或获得D部分低收入补贴的受益人。增加的诊断中只有三分之一是通过病历审查得出的。检测痴呆症的经济激励措施增加了痴呆症的诊断，特别是在痴呆症高危和未被检测出痴呆症的受益人中，但关于潜在的过度诊断或编码升级问题仍然存在。
