Eligible Beneficiaries Research Articles

Medicare Part D plan-selection experience: qualitative findings from a national cross-sectional survey

BackgroundA variety of services exit to assist eligible beneficiaries select Medicare Part D insurance plans; however, selecting an optimal plan remains a challenge. While patients would benefit from evaluating and switching their Medicare Part D plan on a yearly basis, few choose to do so. ObjectiveThe objective of this study was to describe the Medicare Part D plan selection experience across all US states. MethodsThis was a qualitative analysis using data from a cross-sectional Qualtrics panel survey administered in January 2022. Descriptive statistics were generated for demographic and patient-specific items for individuals who provided open-ended survey item responses. Open-coding and content analysis were used to analyze responses to the open-ended survey item. ResultsOverall, 540 responses were received, with the largest number of responses from Florida (11%, 61). A total of 101 respondents (18.7%) of survey respondents provided open-ended comments. Qualitative analysis identified four response categories: Benefit design, Plan information and selection assistance, Plan Switching, and Plan-selection experience. ConclusionsOverall, participants expressed frustrations with high costs and plan restrictions. Many participants needed plan-selection assistance, with some individuals switching plans each year. Recent legislation may address difficulties related to medication costs; however, additional focus on resources and educational interventions may improve the Medicare Part D experience.

Social determinants predict whether Medicare beneficiaries are offered a Comprehensive Medication Review.

Medication reviews through Medicare's Medication Therapy Management (MTM) program may improve patient outcomes and lower health system costs, but these effects could be limited by a program design that does not address social determinants of health. To analyze the effects of social determinants of health on the odds of an eligible Medicare beneficiary not being offered Comprehensive Medication Review (CMR). Using the full 100% sample of the 2016 Part D Medication Therapy Management Data File linked to Medicare Master Beneficiary Summary File, a retrospective, cross-sectional analysis was conducted to determine which social and demographic variables are most strongly associated with being eligible for a CMR but not being offered one. Descriptive statistics were generated using SAS studio 3.8. Variables associated with the highest odds of not receiving a CMR when eligible are residence in Louisiana OR 1.79 (95%CI 1.70-1.88), receiving the LIS OR 1.76 (1.73-1.79), dual eligibility for Medicare and Medicaid OR 1.25 (1.12-1.41), and Black race OR 1.19 (1.16-1.21). Social determinants of health, most strongly geography and low-income status, predict being eligible for but not being offered CMR. Race continues to be a factor in disparate access to MTM services.

RETENTION OF DUALLY ELIGIBLE BENEFICIARIES IN ASSISTED LIVING AT THE END OF LIFE

Abstract To examine to what extent dually eligible beneficiaries (duals) residing in assisted living remain there toward the end of life, we conducted a prospective cohort study of 98,944 Medicare beneficiaries present at validated AL ZIP codes in January 2017, and who died during a two-year follow-up. The outcome was AL residence in the last 30 days of life. We compared decedents who were not duals (80,156 decedents), with those newly dually eligible in 2017-2018 (3,722 decedents), and those already dually eligible in 2016 (15,066 decedents). Only 36.7% of new dual decedents resided in AL in the last 30 days of life, compared to 66.2% among those dually eligible in 2016, and 84.5% of those without Medicaid. While 29 states retained over half of all decedents in AL until death, only 8 states retained a majority of dually eligible decedents.

Changes in spending and quality after ACO contract participation for dually eligible beneficiaries with mental illness

BackgroundFragmented care and misaligned payment across Medicare and Medicaid lower care quality for dually eligible beneficiaries with mental illness. Accountable care organizations aim to improve the quality and value of care. MethodsUsing Medicare fee-for-service Part A and B claims data from 2009 to 2017 and a difference-in-differences design, we compared the spending and utilization of dually eligible beneficiaries with mental illness that were and were not attributed to Medicare ACO providers before and after ACO contract entry. ResultsDually eligible beneficiaries with mental illness (N = 5,157,533, 70% depression, 22% bipolar, 27% schizophrenia and other psychotic disorders) had average annual Medicare spending of $17,899. ACO contract participation was generally not associated with spending or utilization changes. However, ACO contract participation was associated with higher rates of follow-up visits after mental health hospitalization: 1.17 and 1.30 percentage points within 7 and 30 days of discharge, respectively (p < 0.001). ACO-attributed beneficiaries with schizophrenia, bipolar, or other psychotic disorders received more ambulatory visits (393.9 per 1000 person-years, p = 0.002), while ACO-attributed beneficiaries with depression experienced fewer emergency department visits (−29.5 per 1000 person-years, p = 0.003) after ACO participation. ConclusionsDually eligible beneficiaries served by Medicare ACOs did not have lower spending, hospitalizations, or readmissions compared with other beneficiaries. However, ACO participation was associated with timely follow-up after mental health hospitalization, as well as more ambulatory care and fewer ED visits for certain diagnostic groups. ImplicationsACOs that include dually eligible beneficiaries with mental illness should tailor their designs to address the distinct needs of this population.

Government Social Workers Fight Virus and Public Criticism: The Implementation of Social Amelioration Program During Covid-19 Pandemic in the Philippines

This paper talks about the issues surrounding the implementation of the Social Amelioration Program (SAP) by the Philippine government and how the social workers are caught between looking after themselves in this pandemic, being vigilant against criticisms, and making credible decisions on the eligibility of people who are going to avail SAP. In critically analyzing the issues and power relations, the paper presents two ideas: (a) analyzing the perspectives of the government and citizens on deciding who are eligible beneficiaries of the program using the deservingness theory which best describes the perspectives in play in the decision making and how these perspectives create tension in the implementation of the program; and (b) analyzing the power perspectives of the social worker, using Michel Foucault’s ideas of power, which help social worker maintain professionalism, remain optimistic about their profession, make sound judgments amidst all the noises of the bureaucracy, public doubts, criticism and possibly burn out.

Delays in access to an Alzheimer’s treatment for individuals dually eligible for Medicare and Medicaid in the U.S.

AbstractBackgroundPrior research has predicted substantial wait times for access to a disease‐modifying Alzheimer’s treatment because of the combination of a highly prevalent disease and a complex diagnostic process. Access could be particularly limited for individuals dually eligible for Medicare and Medicaid in the U.S. in some states. Medicaid programs cover Medicare cost‐sharing requirements for their indigent members, but under the so‐called “lesser of” policy, states may elect to pay only up to the Medicaid rate which is typically less than the Medicare rate. In states with that policy, providers will only receive the lower Medicaid rate, which is known to reduce appointment availability. We estimate the effect of the policy on wait times.MethodWe use a Markov model to predict wait times for dually eligible and regular Medicare beneficiaries. Counts of both groups by age, sex and states came from Census data and Medicare enrollment records, specifics of each state’s Medicaid policy from published data and inquiries to states, and prevalence and incidence data as well as price elasticity of supply from published data.ResultAt total of 35 states and the District of Columbia have a “lesser of” policy and pay less than the Medicare rate for elective specialty care. The average wait time for dually eligibles is between 5.9 and 48.5 months with an average of 17.5 compared to between 3.6 and 42.5 with an average of 13.8 for regular Medicare beneficiaries in those states. Conversely, wait times are indistinguishable in states without that policy, as Figure 1 illustrates. As Figure 2 shows, the difference means that duals have a 30.3% higher average wait times than regular Medicare beneficiaries with a range of 61.2% in DC and 1.2% in Georgia.ConclusionThe “lesser of” policy is likely to reduce access for the socio‐economically disadvantaged group of dually eligibles, who also suffer from a higher disease burden. The delays would translate into avoidable disease progression and mortality, raising concerns about health equity.

MEDIATING ROLE OF PRINT MEDIA IN SHAPING AWARENESS AND PERCEPTION ABOUT KISAN SAMMAN NIDHI SCHEME: A STUDY ON FARMERS OF GORAKHPUR DISTRICT UTTAR PRADESH

A quantitative study was carried out to identify farmers' awareness level and perception towards the Kisan Samman Nidhi Scheme of the central government. The government's PM-Kisan program, also known as the Pradhan Mantri Kisan Samman Nidhi Scheme, offers financial support to small and marginal farmers. The government will give all eligible beneficiaries Rs. 6000 a year in three instalments under this scheme. The objective of the study is to gauge the level of awareness and perception of the farmers towards the scheme furthermore to assess the role of Print Media for the same. For this purpose, 80 beneficiaries of the Kisan Samman Nidhi Scheme were taken as study respondents from Jangal Dhoosar and Jangle Rani Kuanri Suhas villages of Gorakhpur district, Uttar Pradesh. The data reveals that all the respondents (n = 80) were aware of the Kisan Samman Nidhi Scheme. 68 respondents (85%) have the basic knowledge of the Kisan Samman Nidhi Scheme. However, about 10 of the respondents (12.5 %) were moderate and 2 of the respondents (2.5 %) were advanced in their level of knowledge about the Kisan Samman Nidhi Scheme. According to the study findings, approximately (92.5 %) of respondents thought the Kisan Samman Nidhi Scheme was very good, while (5%) believed it was good and (2.5%) said it was average. This specifies that a positive perception has been built towards the Kisan Samman Nidhi Scheme.

Assessing the impact of the COVID-19 infodemic on older people in the region of Crete

Abstract The COVID-19 pandemic has been accompanied by an unprecedented infodemic, a key global public health challenge. Older people are more susceptible to COVID-19 and to misinformation, with WHO indicating the need for research on how people process and manage information in physical and digital environments to better understand how this phenomenon affects individuals. A qualitative study was developed in to explore the infodemic impact on elderly groups (eligible beneficiaries, aged 60-75 y, users of social services in the Heraklion Regional Unit, Crete Greece). Preliminary results indicate low trust levels for information delivered online and through media. Physicians remain the most trusted and preferred source of information, yet participants questioned their expertise level given the various issues emerging during the pandemic. Most of them report poor quality, incomplete information and point out the misleading role of media pluralism. Key topics of concern include the origin of SARS-CoV-2 and the safety and effectiveness of COVID-19 vaccines. The majority strongly believes that coronavirus is of lab origin, as they have read on the Internet. They are also susceptible to fake news and myths surrounding COVID-19 vaccines. Many of them also suffer from “pandemic fatigue”, i.e., information overload, preferring not to further follow COVID-19 updates. Fear about their vulnerability was the major factor mentioned regarding scientific evidence, stating they prefer information to be conveyed clearly and in an understandable manner. Some exchange information with relatives and friends whilst others prefer not to discuss COVID-19, unless they consider the other person knows more than they do. Nevertheless, they all believe they make the best choices on how to protect their health, whilst having mixed feelings about the manner and content of communication received both in physical and digital environments. Key messages • COVID-19 care for the elderly should encompass infodemic management elements, incl. information presented using simple terms, from updated and regularly verified sources, ideally in printed form. • Health and social care professionals’ training should include media discourse, compassionate care, and motivational communication techniques rather than directional speeches of coercion and fear.

A qualitative exploration of patient preferences for Medicare Part D consultation services offered in a community pharmacy setting

BackgroundCommunity pharmacies currently offer Medicare Part D consultation services to help eligible beneficiaries select prescription medication insurance. Despite these service offerings, there is a paucity of information on patient preferences for these service offerings and optimal service delivery from the patient perspective. ObjectivesThe objectives of this study were to (1) evaluate patient expectations of and willingness-to-pay (WTP) for community pharmacy Medicare Part D consultation services, (2) identify components of Medicare Part D consultation services associated with service quality, and (3) explore differences in preferences and service expectations between services-experienced and service-naive patients. MethodsThis was a qualitative exploratory study, with data collected using interviews and a follow-up supplemental survey with participants recruited from 5 community pharmacies across the state of Iowa participating in the Community Pharmacy Enhanced Services Network. A total of 17 patients contacted the research team for participation. Interviews were recorded and transcribed, with qualitative data analysis performed using template analysis guided by the SERVQUAL framework. Interview participants were invited to complete a supplemental survey. Descriptive statistics and frequencies were generated for survey items. Service-experienced and service-naive survey responses Pearson chi-square and Welch t tests were used to determine significant differences between service-experienced and service-naive responses for categorical and continuous variables, respectively. ResultsIn total, all 17 patients who contacted the research team agreed to participate in interviews, with 8 service-experienced and 9 service-naive interviews completed. Template analysis identified 14 subdomains across the SERVQUAL domains. Similarities and differences in service preferences between groups were identified, focusing on patient-pharmacist trust, past service experience, and WTP. All interview participants completed supplemental surveys, with no statistically significant differences between service-experienced and service-naive participant characteristics identified. ConclusionsService-experienced patients emphasized components of the service that contribute to service quality and generally reported higher WTP values. Many service-naive patients were unaware community pharmacies provided consultation services, suggesting that pharmacists may benefit from considering how services are offered to patients based on the specific preferences and expectations and consider ways to increase awareness of service offerings.

The Massachusetts Infertility Insurance Mandate: not nearly enough

To assess the impact of statutory federal and state exceptions to the state law mandating insurance coverage for the diagnosis and treatment of infertility. Population-based cross-sectional study comprised of reproductive-age women (defined herein as 20-44 years of age) who resided in Massachusetts during the 2016-2019 interval. Statutory exemptions to the benefits afforded by the Massachusetts Infertility Insurance Mandate were identified in the Massachusetts General Laws as well as in the United States Code. Not applicable. Publicly available, deidentified, population-level data pertaining to state-based reproductive-age women (aged 20-44 years) were procured for the 2016-2019 interval. Data sources included the Massachusetts Census Bureau, Massachusetts Center for Health Information and Analysis, US Department of Defense, and US Office of Personnel Management. None. The proportion of state-based reproductive-age women who constitute beneficiaries of the Massachusetts Infertility Insurance Mandate after accounting for the applicable state and federal statutory exemptions that limit its impact. Public health plans (Medicare, MassHealth [state Medicaid], TRICARE, and the Federal Employees Health Benefits Program) are exempted from the Massachusetts Infertility Insurance Mandate by dint of federal or state statute. Self-insured employer-sponsored health plans are exempted from the Massachusetts Infertility Insurance Mandate by dint of the federal Employee Retirement Income Security Act. It follows that only 26.2%-36.0% of state-based reproductive-age women comprised eligible beneficiaries of the Massachusetts Infertility Insurance Mandate over the 2016-2019 interval. Contrary to commonly held views, multiple statutory exemptions to the Massachusetts Infertility Insurance Mandate render a significant proportion of state-based reproductive-age women ineligible for its cognate benefits. We propose herein that the Essential Health Benefit categories of the Affordable Care Act be expanded by the US Congress to include infertility care services.

Implications of the Merit-Based Incentive Payment System for Urology Practices

To determine the implications of the merit-based incentive payment system (MIPS) for urology practices. MIPS is a Medicare payment model that determines whether a physician is financially penalized or receives bonus payment based on performance in four categories: quality, practice improvement, promotion of interoperability, and spending. We performed a cross-sectional analysis of urologist performance in MIPS for 2017 and 2019 using Medicare data. Urologist practice organization was categorized as single-specialty (small, medium, large) or multispecialty groups. MIPS scores were estimated by practice organization. Logistic regression models were used to examine the association between urology practice characteristics, including proportion of dual eligible beneficiaries, and bonus payment adjustment as defined by Medicare methodology. Rates of consolidation (movement from smaller to larger practices) between 2017 and 2019 were compared between those who were and those who were not penalized in 2017. Urologists in small practices performed worse in MIPS and had a significantly lower adjusted odds ratio of receiving bonus payments in both 2017 and 2019 compared to larger group practices (odds ratio [OR] 0.04, 95% confidence interval [95%CI] 0.03-0.05 in 2017 and OR 0.37, 95%CI 0.30-0.47 in 2019). Increasing percent of dual eligible beneficiaries within a patient panel was associated with decreased odds of receiving bonus payment in both performance years. Urologists penalized in 2017 had higher rates of consolidation by 2019 compared to those who were not (14% vs 5%, P <.05). Small urology practices and those caring for a higher proportion of dual eligible beneficiaries tended to perform worse in MIPS.

Evolution of the Comprehensive Medication Review Completion Rate for Medicare Part D Plans: What Do the Stars Tell Us?

Objective To describe changes in the Medicare Part D Comprehensive Medication Review (CMR) completion rate within the Centers for Medicare & Medicaid Services (CMS) Star Ratings program since its inception. Methods Publicly available information for Star Ratings years 2014 to 2021 was obtained from the CMS website and through indexed literature and internet searches. Data elements for the CMR completion measure were extracted for Medicare Advantage prescription drug plans (MA-PDs) and prescription drug plans (PDPs) and included the annual weighted value, cut-points for star rating, completion rates, and star achievement. Results In 2014 and 2015, the CMR completion rate was a display measure in the Star Ratings program with rates between 10 and 16%. This measure was added in 2016 with a weighted value of 1 that has remained the same. The cut-points when comparing 2016 with 2021 have increased from less than 13.6 to less than 48% for 1 star and 76 to 89% or more for 5 stars for MA-PDs and from less than 8.5 to less than 24% for 1 star and 36.7 to 61% or more for 5 stars for PDPs. From 2016 to 2021, the average Star Ratings for CMR completion increased from 2.3 to 3.7 for MA-PDs and 2.3 to 3.6 for PDPs. Conclusion Since the inception of the CMR completion rate as a quality measure, an increasing proportion of eligible beneficiaries has received a CMR with MA-PDs consistently providing this service to more beneficiaries than PDPs. The cut-points for star achievement have also risen, requiring higher CMR completion rates to achieve higher star ratings. Further evolution of the CMR quality measure is needed for improving medication management.

Projected Impact of the Medicare Part D Senior Savings Model on Diabetes-Related Health and Economic Outcomes Among Insulin Users Covered by Medicare.

The Medicare Part D Senior Savings Model (SSM) took effect on 1 January 2021. In this study we estimated the number of beneficiaries who would benefit from SSM and the long-term health and economic consequences of implementing this new policy. Data for Medicare beneficiaries with diabetes treated with insulin were extracted from the 2018 Medical Expenditure Panel Survey. A validated diabetes microsimulation model estimated health and economic impacts of the new policy for the 5-year initial implementation period and a 20-year extended policy horizon. Costs were estimated from a health system perspective. Of 4.2 million eligible Medicare beneficiaries, 1.6 million (38.3%) would benefit from the policy, and out-of-pocket (OOP) costs per year per beneficiary would decrease by 61% or $500 on average. Compared with non-White subgroups, the White population subgroups would have a higher proportion of SSM enrollees (29.6% vs. 43.7%) and a higher annual OOP cost reduction (reduction of $424 vs. $531). Among the SSM enrollees, one-third (605,125) were predicted to have improved insulin adherence due to lower cost sharing and improved health outcomes. In 5 years, the SSM would 1) avert 2,014 strokes, 935 heart attacks, 315 heart failure cases, and 344 end-stage renal disease cases; 2) gain 3,220 life-years and 3,381 quality-adjusted life-years (QALY); and 3) increase insulin cost and total medical cost by $3.5 billion and $2.8 billion. In 20 years, the number of avoided clinical outcomes, number of life-years and QALY gained, and the total and insulin cost would be larger. The Medicare SSM may reduce the OOP costs for approximately one-third of the Medicare beneficiaries treated with insulin, improving health outcomes via increased insulin adherence. However, the SSM will also increase overall Medicare spending for insulin and overall medical costs, which may impact future premiums and benefits. Our findings can inform policy makers about the potential impact of the new Medicare SSM.

Examining transitions of care among nursing home residents with and without antipsychotic medication use

Objectives This study examines the association between antipsychotic (AP) medication use and care transitions in the nursing home (NH) population. Methods This cross-sectional study used data from a 5% random sample of Medicare beneficiaries between 2011 and 2015. Propensity score adjusted negative binomial regression was performed and conditional probabilities of having a first transition from the NH to specific locations were calculated. Results Among 150,284 eligible beneficiaries, the majority were female (67%), white (84%), and >75 years old (63%). Controlling for resident characteristics, the odds of having any transition was 5% lower among those with AP use [IRR (95% confidence interval (CI))=0.95(0.94–0.96)] relative to those with no AP use. Residents with AP use had higher proportions of transitions to hospital (22.7% vs. 19.5%, p < 0.01), emergency department (19.6% vs. 10.7%, p < 0.01), and different NH (1.5% vs. 0.4%, p < 0.01), and lower proportions of transition to non-healthcare locations compared to those without AP use. Conclusions Findings demonstrate that residents with AP use had higher probabilities of transitions to more costly care settings such as the emergency department and hospital compared to those without AP use. Future longitudinal studies will help to inform clinical interventions aimed at improving the quality of care for this population.

Cost-Effectiveness of Waiving Coinsurance for Follow-Up Colonoscopy after a Positive Stool-Based Colorectal Screening Test in a Medicare Population.

Follow-up colonoscopy after a positive stool-based test is necessary to complete the colorectal cancer-screening process. This analysis demonstrated that in a simulated Medicare population, waiving coinsurance for a follow-up colonoscopy improved estimated outcomes and was cost-effective when it was assumed that waiving the coinsurance modestly increased screening adherence. See related Spotlight, p. 641.

Use of North Carolina Medicaid Collaborative Care Billing Codes After Statewide Approval for Reimbursement.

Effective October 2018, North Carolina Medicaid approved reimbursement for collaborative care model (CoCM) billing codes. From October 2018 through December 2019, only 915 of the estimated two million eligible Medicaid beneficiaries had at least one CoCM claim, and the median number of claims per patient was two. Availability of reimbursement for CoCM Medicaid billing codes in North Carolina did not immediately result in robust utilization of CoCM. Furthermore, the low median number of claims per patient suggests lack of fidelity to CoCM. A better understanding of barriers to CoCM implementation is necessary to expand utilization of this evidence-based model.

Mammography and Decision Aid Use for Breast Cancer Screening in Older Women

Decision aids for breast cancer screening are increasingly being used by physicians, but the association between physician practice decision-aid use and mammography rates remains uncertain. Using national data, this study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems (n=1,236) were linked to 2016 and 2017 Medicare fee-for-service beneficiary data from eligible beneficiaries (n=439,684) aged 65-74 years. In 2021, multivariable generalized linear models estimated the association of practice decision-aid use for breast cancer screening and advanced health information technology functions with mammography use, controlling for practice and beneficiary characteristics. Overall, 60.1% of eligible beneficiaries had a screening mammogram, and 37.3% of physician practices routinely used decision aids for breast cancer screening. In adjusted analyses, advanced health information technology functions (OR=1.19, p=0.04) were associated with mammography use, but practice use of decision aids was not (OR=0.95, p=0.21). Beneficiary clinical and socioeconomic characteristics, including race, comorbidities, Medicare and Medicaid eligibility, and median household income were more strongly associated with mammography use than practice-level decision-aid use or advanced health information technology functions. Health information technology‒enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision. More resources may be needed for decision aids to be routinely implemented to improve solicitation of patient preferences and targeting of mammography services.

491-P: Ten Years of the National Diabetes Prevention Program: Scaling the Lifestyle Change Program across the United States

The National Diabetes Prevention Program (National DPP) is a public-private partnership to build a nationwide delivery system for an evidence-based lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes. Using data collected through the Diabetes Prevention Recognition Program (DPRP) , which certifies programs as official National DPP sites since 2012, this study shows how programmatic milestones have impacted enrollment trends over the past years. At the end of 2012, only 13 states had enrolled participants, with the highest number reported by MT (269) . By 2013, the number of states with programs increased to 41, with the highest number of enrollees reported by OH (931) and FL (840) . In 2015, online delivery modes were introduced, this allowed participants to enroll in programs located outside of their current states of residence and led, to an increase in enrollment across 50 states and DC. Notable increases were then seen in IL (13 to 670) , KS (9 to 786) , and LA (59 to 1362) . In January 2018, the Medicare Diabetes Prevention Program (MDPP) was launched, which allowed eligible Medicare beneficiaries to enroll in the LCP as a covered service. By the end of 2018, in-person (IP) enrollment sharply increased in organizations approved as MDPP suppliers, and large increases in IP enrollment from 2017 to 2018 were seen in AL, MO, NJ, and NV. The ongoing COVID-pandemic significantly impacted National DPP enrollment trends. Most states’ online enrollment increased by at least 20% from March 2020 to March 2021, with NC, CO, and NY showing large increases of 176%, 243%, and 590%, respectively. In contrast, CA, DE, and MS had decreases in online enrollment of 7%, 8%, and 26%, respectively. Enrollment trends have proven to be important reflections of milestones in the evolution of the National DPP. Expanding the number of organizations offering the MDPP, as well as those offering virtual delivery, allows the Program to continue to scale. Disclosure A.Chappell: None. E.Ely: None.

0774 Positive Airway Pressure Utilization, Major Adverse Cardiovascular Events Incidence Risk and Mortality in Medicare Beneficiaries with Obstructive Sleep Apnea

Abstract Introduction Positive airway pressure (PAP) is the first line treatment for moderate-severe or symptomatic obstructive sleep apnea (OSA). Randomized controlled trials have established that PAP therapy has beneficial impact on cardiovascular and metabolic functions. However, evidence on the benefits of PAP for preventing major adverse cardiovascular events (MACE) is limited. We aimed to determine the association between PAP utilization and incidence of MACE and all-cause mortality in a large sample of Medicare beneficiaries. Methods Medicare beneficiaries (&amp;gt;65 years) with at least 5 years of consecutive enrollment to part A and B and ≥2 distinct OSA claims were collected from multi-state (Kansas, Missouri, Iowa, Wisconsin, Nebraska, Minnesota, Texas, Utah, North Dakota, South Dakota and Indiana), multi-year (2011-2017) Medicare fee-for-service claims data. We further required at least 1-year enrollment before the first OSA claim. Evidence of PAP utilization and index date was defined based on the first Healthcare Common Procedure Coding System PAP initiation codes (E0601, E0470, E0471) after first OSA diagnosis. MACE was defined as the first occurrence of myocardial infarction, coronary revascularization, stroke, or heart failure (identified by diagnostic and procedure code claims) after PAP initiation. Analyses were adjusted by age at initial OSA diagnosis, sex, race and presence of hypertension, type 2 diabetes, obesity, and evidence of MACE prior to the index date. Results Our sample included 212,445 eligible Medicare beneficiaries with evidence of OSA diagnosis (mean [SD] age 75 [5.7] years; 45.2% women; median [Q1, Q3] follow-up 4 [2.0, 4.9] years at censoring). Five-year MACE cumulative incidence rate was 59.3% and the mortality rate was 17.8%. In adjusted analyses, OSA patients with evidence of PAP utilization (50.8%) had significantly lower MACE incidence risk (HR=0.812; 95%CI=0.803-0.822; p&amp;lt;0.0001) when compared to those without evidence of using PAP. OSA patients with evidence of PAP utilization also had significantly lower mortality risk (HR=0.575; 95%CI=0.560-0.591; p&amp;lt;0.0001). Pre-existing hypertension, type II diabetes and obesity were also significantly associated with increased mortality and MACE risk. Conclusion PAP utilization based on device initiation derived from claims data is associated with lower MACE incidence and mortality in older adults that are Medicare beneficiaries. Support (If Any) American Heart Association (20CDA35310360), Patient-Centered Outcomes Research Institute (RI-CRN-2020-003-IC); NIH CTSA NCATS Frontiers: University of Kansas Clinical and Translational Science Institute (UL1TR002366); Tier 2 grant, University of Missouri.

United Kingdom’s Income Support Program for People With Disabilities: Redesign, Reform, and Policy Lessons for the United States

We reviewed the operational aspects of Employment and Support Allowance (ESA)—the income support program for people with disabilities in the United Kingdom—and its potential policy lessons for the United States’ Social Security Disability Insurance (SSDI) program. ESA has a five-step eligibility determination process, and eligible beneficiaries receive either an unconditional cash benefit or payments conditional on participating in return-to-work activities. The United Kingdom has reformed ESA to better meet policy objectives. Both ESA and SSDI collect medical documentation, but ESA also requires face-to-face eligibility assessments for almost all claimants. ESA eligibility is based on functional limitations exclusively, whereas SSDI assesses the ability to perform substantial work. With its focus on helping some beneficiaries return to work, ESA differs from SSDI, which requires no return-to-work efforts to receive benefits. ESA might offer policy lessons for SSDI with regard to pilot testing, program reform, and accurate decision making.