A new study led by a physician-scientist from the University of Pittsburgh School of Medicine found that patients with diabetes on Medicare Advantage plans are more likely to receive preventive care but are less likely to be prescribed newer, more expensive medications and are more likely to have higher blood pressure and poorer blood glucose control than patients on Medicare Fee-For-Service plans.
The study, which was just published in Diabetes Care, raises the alarm that, despite better access to preventive care, a trend toward worse health outcomes and inequities in care may be emerging among Medicare Advantage members as compared to their Medicare Fee-For-Service counterparts.
According to the lead author, Utibe Essien, “Preventive treatments are not enough to keep patients from utilizing the health care system down the road. We need to make sure the right patients are getting the right treatment, likely a combination of preventive and therapeutic interventions.”
One in five Medicare beneficiaries aged 65 and older with diabetes report having out-of-pocket pharmaceutical expenses that are more than 60% greater than those of people without diabetes.
In order to investigate approximately 350,000 individuals with Type 2 diabetes who were 65 years of age or older and enrolled in Medicare Advantage or Medicare Fee-For-Service plans, the researchers collected data from more than 5,000 clinicians who take part in The Diabetes Collaborative Registry. They evaluated the two groups’ quality measures, preventive care, and prescription habits.
According to the study, Medicare Advantage enrollees had a higher likelihood of getting screenings, foot care, and other preventive treatments like quitting smoking. However, people on Medicare Advantage plans also had higher blood pressure and worse diabetes control than those on Medicare Fee-For-Service plans, and they were also less likely to receive newer, evidence-based drugs. In order to reduce healthcare costs, Medicare Advantage employs a range of tactics, such as restricting access to newer, more expensive medications.
Medicare Advantage beneficiaries were appropriately administered older, generic diabetes drugs such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Essien noted that despite clear evidence that newer, more expensive medications like sodium/glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) benefit patients with diabetes by lowering kidney disease, cardiovascular disease, and death rates, “we saw a clear drop in Medicare Advantage enrollees getting those medications.”
“With Medicare Advantage plans continuing to rapidly expand and now covering nearly half of all Medicare beneficiaries,” added senior author Muthiah Vaduganathan, “these data call for ongoing surveillance of long-term health outcomes under various Medicare plans.”
The researchers are hoping that by using their findings to improve the Medicare Advantage program, patients would be able to receive the care and therapies they require while also lowering expenditures and healthcare consumption.
Essien predicted that more Medicare Advantage subscribers would require high-quality diabetes care as a result of rising diabetes risk factors among Americans.
“I’m a general internist – my primary focus is on prevention – but our data suggest that is not enough.”
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