# The Impact of Medicare Advantage on ADRD Care and Outcomes

> **NIH NIH P01** · BROWN UNIVERSITY · 2020 · $231,731

## Abstract

PROJECT SUMMARY
 Persons with Alzheimer’s Disease and Related Dementias (ADRD) suffer from a 70% increase in mortality
rates, frequent hospitalizations and medical complications, and catastrophic health care spending in the last 5
years of life. Recent policy efforts have focused on two important and related goals to improve ADRD care:
supporting patients’ preferences to remain in their own residence and avoiding potentially unnecessary and
traumatic hospitalizations. However, performance on these objectives is suboptimal, with wide geographic
variation. Virtually all of the prior research on the care and outcomes of patients with ADRD is derived from
patients enrolled in traditional Medicare, with remarkably few studies of persons with ADRD in managed care
plans. This raises a critical gap in knowledge because over the past 12 years, the number of beneficiaries
enrolled in managed care (now called Medicare Advantage) more than tripled from 5.3 million in 2004 to 17.6
million in 2016. Under managed care, plans are paid a capitated rate to bear the risk of paying for covered
services and are held accountable for quality of care. These incentives may yield innovative approaches to
improve care and reduce costs for populations with ADRD. Alternatively, managed care plans may provide
inadequate coverage of necessary services, avoid complex patients, or promote disenrollment among patients
with high spending and intensive health care needs. The objective of this proposal is to evaluate the effects of
the rise of Medicare Advantage on patient-centered outcomes in ADRD. Our working hypotheses are that,
among persons with ADRD, enrollment in managed care will reduce the likelihood of long-term nursing home
care, lower rates of hospitalizations and readmissions, and improve quality of care at the end of life, particularly
among racial/ethnic minorities and plans that focus on dual-eligible patients. However, these effects will be
attenuated after accounting for disenrollment from Medicare Advantage to traditional Medicare. Our specific
aims are: Aim 1. Among patients with ADRD using home health services, examine the effects of Medicare
Advantage on long-term nursing home care and acute hospitalizations; Aim 2. Evaluate the effects of Medicare
Advantage on the outcomes of post-acute care among patients with ADRD; Aim 3. Evaluate the effects of
Medicare Advantage on care at the end of life among patients with advanced dementia; and, Aim 4. Assess
the heterogeneity of these effects across racial/ethnic minority populations and different types of Medicare
Advantage plans. This project will use detailed comprehensive clinical and functional assessment data from all
Medicare-certified home health providers and nursing homes in the US. Further, we will employ an innovative
cross-temporal difference-in-differences approach that leverages the dramatic growth in Medicare Advantage
enrollment from 2007 to 2017 to draw causal inferences. Our contribution is significa...

## Key facts

- **NIH application ID:** 10013106
- **Project number:** 5P01AG027296-12
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** AMAL N. TRIVEDI
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $231,731
- **Award type:** 5
- **Project period:** 2007-09-15 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10013106

## Citation

> US National Institutes of Health, RePORTER application 10013106, The Impact of Medicare Advantage on ADRD Care and Outcomes (5P01AG027296-12). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10013106. Licensed CC0.

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