Patient selection in the ESRD managed care demonstration.
The Centers for Medicare & Medicaid Service's (CMS') end stage renal disease (ESRD) managed care demonstration offered an opportunity to assess patient selection among a chronically ill and inherently costly population. Patient selection refers to the phenomenon whereby those Medicare beneficiaries who choose to enroll or stay in health maintenance organizations (HMOs) are, on average, younger, healthier, and less costly to treat than beneficiaries who remain in the traditional Medicare fee-for-service (FFS) sector. The results presented in this article show that enrollees into the demonstration were generally younger and healthier than a representative group of comparison patients from the same geographic areas.
Shapiro
Jennifer R
JR
Centers for Medicare and Medicaid Services, Baltimore, MD, USA. jshapiro@cms.hhs.gov
Dykstra
Dawn M
DM
Pisoni
Ron
R
Beronja
Nancy
N
Gaylin
Daniel S
DS
Oppenheimer
Caitlin Carroll
CC
Rubin
Robert J
RJ
Held
Philip J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D014487:Centers for Medicare and Medicaid Services, U.S.; D015897:Comorbidity; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015273:Insurance Selection Bias; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D006435:Renal Dialysis / Q000191:economics*; D012959:Socioeconomic Factors; D014481:United States