title: Medicare Advantage associated with lower mortality for incident dialysis patients.
abstract: Physicians across the care continuum are increasingly aligned around the belief that coordinated care can improve patient outcomes. As the principal caregivers for one of the most medically fragile patient groups in healthcare, nephrologists are especially attuned to the potential value of integrated care. Medicare Advantage (MA) offers one way to test this hypothesis. By law, end-stage renal disease patients currently cannot enroll into an MA plan, but if they develop ESRD while in such a plan, they may continue to be enrolled. The contrast between these patients and their counterparts who carry Medicare fee for service (MFFS) thereby represents a natural experiment that affords an opportunity to examine whether enrollment in a coordinated care system may improve outcomes. In order to promote (unbiased) comparison of patients in a non-randomized context, we propensity score-matched incident dialysis patients enrolled in MA versus those in MFFS. The data demonstrate that patients who were enrolled in an MA plan upon initiation of dialysis had a 9% lower mortality rate than their MFFS counterparts. This beneficial association of MA enrollment was found to be sustained over the first two years of dialysis treatment.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
authors.forename: Scott
authors.initials: S
authors.lastname: Sibbel
authors.forename: Carey
authors.initials: C
authors.lastname: Colson
authors.forename: Abigail
authors.initials: A
authors.lastname: Hunt
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D020398:Medicare Part C; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics* / Q000401:mortality*; D014481:United States / Q000453:epidemiology