While patients with diabetes on Medicare Advantage plans were more likely to receive preventive treatments, they were less likely to receive newer, more expensive medications and were more likely to have higher blood pressure and poorer blood glucose control than patients on Medicare Fee-For-Service plans. , according to a new study led by a physician scientist at the University of Pittsburgh School of Medicine.
The study, published today in Diabetes Care, raises a red flag that — despite improving access to preventive care — rapid growth in Medicare Advantage enrollees may predict a trend toward worse health outcomes and inequalities in care compared to their Medicare Fee-For-Service counterparts.
“Preventive treatments are not enough to prevent patients from using the health care system later on,” says lead author Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the VA Pittsburgh Healthcare System. “We need to make sure the right patients get the right treatment, probably a combination of preventive and therapeutic interventions.”
Diabetes is reported in 1 in 5 Medicare beneficiaries age 65 and older and is associated with more than 60% higher over-the-counter prescription costs compared to people without diabetes.
The researchers used data from more than 5,000 clinicians participating in The Diabetes Collaborative Registry to study nearly 350,000 patients with type 2 diabetes Age 65 or older on Medicare Advantage or Medicare Fee-For-Service plans. They compared quality statistics, preventive care and prescribing patterns between the two groups.
The study found that patients with Medicare Advantage were more likely to receive preventive treatments, such as smoking cessation, foot care and other screenings. However, patients on Medicare Advantage plans were also more likely to have higher blood pressure and poorer diabetes control, and were less likely to receive newer evidence-based medications than their counterparts on Medicare Fee-For-Service plans. Medicare Advantage uses several strategies to reduce healthcare costs, including limiting access to newer and more expensive medications.
Older, generic diabetes medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), were appropriately prescribed to Medicare Advantage beneficiaries. But when it came to newer, more expensive drugs — such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i) — Essien said, “We saw a marked decline in Medicare Advantage enrollees who receive those drugs despite unequivocal evidence that they benefit patients with diabetes by reducing kidney disease, cardiovascular disease, and death.”
“As Medicare Advantage plans continue to grow rapidly and now cover nearly half of all Medicare beneficiaries, this data calls for ongoing monitoring of long-term health outcomes under various Medicare plans,” said senior author 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.
The researchers hope these findings can help refine the Medicare Advantage program, enabling patients to access the care and treatments they need while keeping health care costs and utilization low.
“Given the increasing risk factors for diabetes among Americans, we will see more and more Medicare Advantage enrollees need quality diabetes care,” Essien said. “I’m a general internist — my primary focus is prevention — but our data suggests that’s not enough.”
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