Project Grant K08DK147769

The National Institute of Diabetes and Digestive and Kidney Diseases awarded The Leland Stanford Junior University $169,991 on September 1, 2026, under the Diabetes, Digestive, and Kidney Diseases Extramural Research program (CFDA 93.847) to conduct a quasi-experimental evaluation of Medicare Advantage enrollment effects on dialysis care and outcomes.

The research addresses a critical evidence gap created when the 21st Century Cures Act lifted the prohibition on Medicare Advantage enrollment for patients with end-stage kidney disease, resulting in more than half of all Medicare beneficiaries receiving dialysis now enrolled in Medicare Advantage plans. Most existing research focused on fee-for-service Medicare populations due to data limitations. The project will estimate Medicare Advantage's real-world impact on prescription drug adherence, branded versus generic medication use, out-of-pocket spending, emergency department visits, hospitalizations, missed dialysis treatments, and dialysis vascular access using quasi-experimental methods. A third aim will identify patient-level and regional characteristics associated with Medicare Advantage enrollment, including comorbidities, income, financial stress, and plan selection behavior. The research draws on comprehensive Centers for Medicare and Medicaid Services data including fee-for-service and Medicare Advantage claims and encounter files, supplemented by patient-reported measures from linked national survey data.

The award includes a structured career development plan for Principal Investigator Jillian Caldwell, DO, MS, to prepare her for an independent research career under training at Stanford University. The performance period runs through May 31, 2031, with work performed in Palo Alto, California.