# Does Managed Care Improve End-of-Life Care for Medicare Beneficiaries?

> **NIH NIH R56** · JOHNS HOPKINS UNIVERSITY · 2021 · $1

## Abstract

PROJECT SUMMARY
Numerous studies and a recent Institute of Medicine report have raised concerns about the quality of end-of-
life (EOL) care provided to older adults in the United States. Many Medicare beneficiaries receive burdensome
treatments (e.g. feeding tube placement, dialysis, and intensive care unit stays) that do not extend their life, die
in a hospital, and experience transitions from one setting of care to another late in life. These treatments come
at significant financial and emotional cost to the Medicare program, individual beneficiaries and their families,
and are associated with the financial incentives and fragmented delivery system embedded in Fee-for-Service
(FFS) Medicare. Despite repeated calls to improve patient experiences at the end-of-life (EOL), especially for
older adults with Alzheimer's Disease and Related Dementias (ADRD) and other life-limiting illness, little
research has considered whether managed care could achieve these goals.
Medicare Advantage (MA), the voluntary, managed care alternative to FFS now covers 33% of Medicare
beneficiaries at time of death. MA plans receive capitated payments for each beneficiary and are shielded
from the cost of most care provided to beneficiaries who enroll in hospice care. These incentives may
encourage provision of high-quality EOL care for terminally ill patients. While a small number of descriptive
studies point to more appropriate EOL care provision with managed care, the literature has not yet accounted
for non-random enrollment in MA, studied MA across market conditions, assessed EOL care for patients with
life-limiting illness in MA or examined outpatient EOL care in MA.
To address this gap, our team of health economists, health services researchers, physicians and nurse
practitioners will use econometric methods with Medicare claims data from 2015 – 2018 including newly
available Medicare Advantage encounter data to assess whether and how managed care enrollment affects
care for patients with life-limiting illnesses (ADRD, metastatic cancer and end-stage organ failure). We will 1-
test whether MA reduces use of potentially inappropriate care near the end-of-life for these patients; 2- assess
whether MA provides better outpatient care near the end-of-life to reduce potentially burdensome transitions;
and 3- test whether the effect of MA varies with local practice styles, plan payments, and MA market share.
The end-of-life represents the most intensive period of healthcare utilization for many Americans. With one-
third of Medicare beneficiaries now receiving coverage through MA, it is critical to understand potential
differences in the quality of care provided at this time. Information about differences between managed care
and traditional Medicare is essential to understand how financial incentives influence EOL care and to develop
incentives that better align with patient preferences.

## Key facts

- **NIH application ID:** 10490500
- **Project number:** 1R56AG065369-01A1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Lauren Hersch Nicholas
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $1
- **Award type:** 1
- **Project period:** 2021-09-30 → 2021-10-06

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10490500

## Citation

> US National Institutes of Health, RePORTER application 10490500, Does Managed Care Improve End-of-Life Care for Medicare Beneficiaries? (1R56AG065369-01A1). Retrieved via AI Analytics 2026-06-24 from https://api.ai-analytics.org/grant/nih/10490500. Licensed CC0.

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