{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T03:40:31Z","timestamp":1792208431404,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK129388"],"award-info":[{"award-number":["R01DK129388"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2010stage 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>Interviews were conducted from January 2022 to May 2024. Deductive and inductive coding methods were used and organized around Donabedian's structure\u2010process\u2010outcomes framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principle Findings<\/jats:title>\n                    <jats:p>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\u2010network facilities. Concerning specialists, frontline staff reported patients were often unaware of network restrictions limiting access. Regarding transplant, MA plans noted selecting \u201ccenters of excellence,\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70175","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:51:54Z","timestamp":1792205514000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Organizational Perspectives on Access to Care Among Persons With End\u2010Stage Kidney Disease After Enrollment in Medicare Advantage"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8555-9011","authenticated-orcid":false,"given":"Denise A.","family":"Tyler","sequence":"first","affiliation":[{"name":"Scripps Gerontology Center Miami University  Oxford Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0850-7626","authenticated-orcid":false,"given":"Joan F.","family":"Brazier","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy &amp; Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur D.","family":"Shah","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University  Providence Rhode Island USA"},{"name":"Division of Nephrology Rhode Island Hospital  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal N.","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy &amp; Practice Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Providence VA Medical Center  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1643-2732","authenticated-orcid":false,"given":"Emily A.","family":"Gadbois","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy &amp; Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"MedPAC \u201cReport to the Congress: Medicare Payment Policy \u201d(2024 accessed June 14 2025) https:\/\/www.medpac.gov\/wp\u2010content\/uploads\/2024\/03\/Mar24_Ch5_MedPAC_Report_To_Congress_SEC.pdf."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010024\u201008876\u20107"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14308"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.7639"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010020\u201006534\u20102"},{"issue":"16","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1001\/jama.2024.13531","article-title":"How Affordable Is Medicare Advantage?","volume":"332","author":"Blumenthal D.","year":"2024","journal-title":"Journal of the American Medical Association"},{"issue":"10","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1001\/jama.2023.1426","article-title":"Medicare Advantage Enrollment Among Beneficiaries With End\u2010Stage Renal Disease in the First Year of the 21st Century Cures Act","volume":"329","author":"Nguyen K. 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