Health services research · 2026
Organizational Perspectives on Access to Care Among Persons With End-Stage Kidney Disease After Enrollment in Medicare Advantage.
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Tyler Denise A, Brazier Joan F, Shah Ankur D, Trivedi Amal N, Gadbois Emily A
Аннотация
OBJECTIVE: To examine Medicare Advantage (MA) plan, dialysis provider organization, and kidney care management company perspectives on how MA enrollment impacts access to care among persons with end-stage kidney disease (ESKD). The 21st Century Cures Act enabled persons with ESKD to enroll in MA, resulting in over 70% growth in enrollment among this group. However, the impact of MA enrollment on access to healthcare and services for people with ESKD remains unknown.
STUDY SETTING AND DESIGN: This was a qualitative study that included 48 semistructured interviews with 56 participants representing eight MA plans, six dialysis provider organizations, and five kidney care management companies across all US regions.
DATA SOURCES AND ANALYTIC SAMPLE: Interviews were conducted from January 2022 to May 2024. Deductive and inductive coding methods were used and organized around Donabedian's structure-process-outcomes framework.
PRINCIPLE FINDINGS: Perspectives diverged by organization and staff type across four themes. Regarding dialysis access, MA plan and large dialysis organization representatives reported no barriers for patients, while small dialysis providers described patients traveling farther to in-network facilities. Concerning specialists, frontline staff reported patients were often unaware of network restrictions limiting access. Regarding transplant, MA plans noted selecting "centers of excellence," while other participants reported these restrictions may be impeding patient access to transplants. For supplementary benefits, executives emphasized their value, while frontline staff reported benefits were often more limited than advertised.
CONCLUSIONS: Participant perspectives suggest MA enrollment may differentially impact access depending on dialysis provider size and MA network restrictions. Persons with ESKD may need additional support to make informed insurance enrollment decisions.
STUDY SETTING AND DESIGN: This was a qualitative study that included 48 semistructured interviews with 56 participants representing eight MA plans, six dialysis provider organizations, and five kidney care management companies across all US regions.
DATA SOURCES AND ANALYTIC SAMPLE: Interviews were conducted from January 2022 to May 2024. Deductive and inductive coding methods were used and organized around Donabedian's structure-process-outcomes framework.
PRINCIPLE FINDINGS: Perspectives diverged by organization and staff type across four themes. Regarding dialysis access, MA plan and large dialysis organization representatives reported no barriers for patients, while small dialysis providers described patients traveling farther to in-network facilities. Concerning specialists, frontline staff reported patients were often unaware of network restrictions limiting access. Regarding transplant, MA plans noted selecting "centers of excellence," while other participants reported these restrictions may be impeding patient access to transplants. For supplementary benefits, executives emphasized their value, while frontline staff reported benefits were often more limited than advertised.
CONCLUSIONS: Participant perspectives suggest MA enrollment may differentially impact access depending on dialysis provider size and MA network restrictions. Persons with ESKD may need additional support to make informed insurance enrollment decisions.