The long and winding road—highlights on the journey as our ACT study became a living learning laboratory of aging
Where: Kaiser Permanente Washington Health Research Institute, 4–5 p.m., Room 1509A/B
Presenter: Eric B. Larson, MD, MPH, MACP, Vice President for Research and Health Care Innovation, Kaiser Foundation Health Plan of Washington, Executive Director and Senior Investigator, KPWHRI
In the lead-up to my coming to Group Health in 2002, I presented a narrative of the evolution of community based research in Seattle starting from the founding of a unique clinic, Geriatric and Family Services, at the University of Washington which led to the award from NIA in 1986 we received to establish the Group Health/University of Washington Alzheimer’s disease patient registry. This project morphed into the Adult Changes in Thought (ACT) study with the formation of a cohort of randomly selected persons without dementia over age 65, 1994-6.
This presentation will briefly set the historical stage and move through the highlights and then describe the current state of the ACT study, which is now an ongoing living laboratory of aging. The seminar will focus especially on current and future research and how ACT can contribute to prevention of cognitive decline and dementia along with enhance our understanding of the aging brain.
Adolescent and Young Adult Cancer in Ontario: A focus on locus of care
Where: Kaiser Permanente Washington Health Research Institute, 10–11 a.m., Room 1509A
Presenter: Jason D. Pole, PhD, Scientist, Pediatric Oncology Group of Ontario (POGO) and Associate Professor, University of Toronto
Cancer is the leading cause of disease-related death in the Adolescent and Young Adult population (AYA). Improvements in survival and research in general of the AYA population lag behind that focused on children and older adults. Location of cancer therapy may exacerbate or mitigate vulnerabilities because this group is transitioning from childhood to adulthood. They may receive care in pediatric or adult systems, neither designed for the specific needs of this vulnerable group. The Initiative to Maximize Progress in Adolescent and Young Adult Cancer Therapy (IMPACT) cohort, a unique AYA data platform that takes advantage of the diverse data resources available in Ontario was established to perform critical analyses that examine the impact of the location of cancer therapy on the entirety of the AYA cancer journey. This talk will introduce the design of the IMPACT cohort and present preliminary findings.
Service-level Selection: Strategic Risk Selection in Medicare Advantage in Response to Risk Adjustment
Where: Kaiser Permanente Washington Health Research Institute, 4–5 p.m., Room 1509A
Presenter: Sungchul Park, PhD Candidate, Department of Health Services, University of Washington
The Centers for Medicare and Medicaid Services (CMS) has phased in the Hierarchical Condition Categories (HCC) risk adjustment model during 2004–2006 to more accurately estimate capitated payments to Medicare Advantage (MA) plans to reflect each beneficiary’s health status. However, it is debatable whether the CMS- HCC model has led to strategic evolutions of risk selection.
We examine the competing claim on the effectiveness of the CMS-HCC model to comprehensively understand strategic risk selection behaviors of MA plans. We find that the CMS-HCC model reduced the phenomenon that MA plans avoid high-cost beneficiaries in traditional Medicare plans, whereas it led to increased disenrollment of high-cost beneficiaries, conditional on illness severity, from MA plans. We explain this phenomenon in relation to service-level selection.
First, we show that MA plans have incentives to effectuate risk selection via service-level selection, by lowering coverage levels for services that are more likely to be used by beneficiaries who could be unprofitable under the CMS- HCC model. Then, we empirically test our theoretical prediction that compared to the pre-implementation period (2001–2003), MA plans have raised copayments disproportionately more for services needed by unprofitable beneficiaries than for other services in the post-implementation period (2007–2009), thereby inducing unprofitable beneficiaries to voluntarily disenroll from their MA plans. Further evidence supporting this selection mechanism is that those dissatisfied with out-of-pocket costs were more likely to disenroll from MA plans. We estimate that such strategic behavior led MA plans to save costs of $5.2 billion in 2007–2009. To counter service-level selection, it may be of value to develop a better risk adjustment model that not only conditions on each beneficiary’s health status but also reflects each beneficiary’s service-level propensity of service use.