Patients with Diabetes on Medicare Advantage More Likely to Have Worse Health Outcomes Despite Preventive Care Access

Patients with diabetes on Medicare Advantage were more likely to have high blood pressure and worse blood glucose control compared with patients on Medicare Fee-For-Service plans, according to a study recently published in Diabetes Care.

Patients with diabetes on Medicare Advantage were also less likely to be prescribed newer, more expensive medications, though they were more likely to receive preventive treatment. The study foreshadows a potential trend toward poorer health outcomes and disparities in care for the growing number of patients on Medicare Advantage compared with those on Medicare Fee-For-Service plans.

Researchers used data from more than 5000 clinicians who participate in The Diabetes Collaborative Registry. The study included nearly 350,000 patients with type 2 diabetes 65 years of age or older on Medicare Advantage or Medicare Fee-For-Service plans.

The researchers compared quality metrics, preventive care, and prescription patterns between the 2 groups.

The study found that older, generic medicines, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), were appropriately prescribed to Medicare Advantage beneficiaries. However, patients on Medicare Advantage plans were less likely to receive newer, evidence-based medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i).

“We saw a clear drop in Medicare Advantage enrollees getting those medications, despite unequivocal evidence that they benefit patients with diabetes by reducing kidney diseases, cardiovascular disease, and death,” said lead author Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the VA Pittsburgh Healthcare System, in a press release.

Medicare Advantage limits access to newer and more expensive medications as a strategy to mitigate the costs of care. Additionally, the results showed that patients with Medicare Advantage were more likely to receive preventive treatments, including tobacco cessation, foot care, and other screenings.

However, despite this increased access to preventive care, Medicare Advantage patients were found to have poorer health outcomes.

“Given the rising risk factors for diabetes among Americans, we’re going to see increasing numbers of Medicare Advantage enrollees needing high-quality diabetes care,” Essien said. “I’m a general internist—my primary focus is on prevention—but our data suggest that is not enough.”

Specifically, the study found that patients on Medicare Advantage plans were more likely to have higher blood pressure and poorer diabetes blood glucose control compared with patients on Medicare Fee-For-Service plans.

“Preventive treatments are not enough to keep patients from utilizing the health care system down the road,” Eissen said in a statement. “We need to make sure the right patients are getting the right treatment, likely a combination of preventive and therapeutic interventions.”

The 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 health care costs and utilization low.

“With Medicare Advantage plans continuing to rapidly expand and now covering nearly half of all Medicare beneficiaries, these data call for ongoing surveillance of long-term health outcomes under various Medicare plans,” 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, concluded in the press release.

Reference

Diabetes patients on Medicare Advantage plans more likely to have worse health, study finds [press release]. Pittsburgh, PA: EurekAlert. July 7, 2022. https://www.eurekalert.org/news-releases/958085. Accessed July 7, 2022.