Patients with diabetes and Medicare Advantage are more likely to have worse health outcomes
Patients with diabetes with Medicare Advantage were also less likely to receive newer, more expensive drugs than patients with Medicare service fee plans, indicating possible disparities in care.
According to a study recently published in Diabetes Care, patients with diabetes on Medicare Advantage were more likely to have high blood pressure and poorer blood glucose control compared to patients with Medicare service payment plans.
Patients with diabetes with Medicare Advantage were also less likely to receive new and more expensive medications, although they were more likely to receive preventative treatment. The study portends a potential trend toward poorer health outcomes and disparities in care for the growing number of Medicare Advantage patients compared to those in Medicare service fee plans.
The researchers used data from more than 5,000 physicians involved in The Diabetes Collaborative Registry. The study included about 350,000 patients with type 2 diabetes aged 65 or older with Medicare Advantage or Medicare Fee-For-Service plans.
The researchers compared quality metrics, preventive care, and prescription patterns between the two groups.
The study found that older generic drugs, such as angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARAs), were adequately prescribed to Medicare Advantage beneficiaries. However, patients with Medicare Advantage plans were less likely to receive newer evidence-based drugs, such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium / glucose-2 cotransporter inhibitors ( SGLT2i).
“We saw a clear drop in Medicare Advantage enrollees receiving these drugs, despite unequivocal evidence that they benefit patients with diabetes by reducing kidney disease, cardiovascular disease and death,” said lead author Utibe Essien, MD, MPH , adjunct professor of medicine at the University of Pittsburgh and VA staff doctor at the Pittsburgh Healthcare System, in a press release.
Medicare Advantage limits access to newer, more expensive drugs as a strategy to mitigate care costs. In addition, the results showed that patients with Medicare Advantage were more likely to receive preventative treatments, such as smoking cessation, foot care, and other controls.
However, despite this increase in access to preventive care, Medicare Advantage patients were found to have poorer health outcomes.
“Given the increasing risk factors for diabetes among Americans, we will see an increasing number of Medicare Advantage enrollees in need of high-quality diabetes care,” Essien said. “I’m a general internist. My main focus is prevention, but our data suggests it’s not enough.”
Specifically, the study found that patients with Medicare Advantage plans were more likely to have higher blood pressure and poorer blood glucose control compared to patients with Medicare service rate plans.
“Preventive treatments are not enough to prevent patients from using the healthcare system in the future,” Eissen said in a statement. “We need to make sure that the right patients receive the right treatment, probably a combination of preventive and therapeutic interventions.”
Researchers hope their findings can help guide improvements in the Medicare Advantage program, allowing the growing number of patients to access necessary care and treatments while keeping healthcare costs and utilization low.
“With Medicare Advantage plans continuing to expand rapidly and now covering nearly half of all Medicare beneficiaries, these data call for continued monitoring of long-term health outcomes under various Medicare plans,” the author principal Muthiah Vaduganathan, MD, MPH, co-director of the Center for Implementation Science and staff cardiologist at Brigham and Women’s Hospital and Harvard Medical School, concluded in the press release.