Medicare Advantage tops traditional Medicare on diabetes
The spending on diabetes care is significant, at over $240B annually, with the Medicare program responsible for nearly 60%.
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Medicare Advantage patients fare better on diabetes outcomes than their counterparts in traditional fee-for-service Medicare, according to new findings from Avalere Health and the Better Medicare Alliance.
This has implications for older Americans especially, since data from the Centers for Medicare and Medicaid Services indicates that nearly one third of people aged 65 and older have Type 2 diabetes – a chronic condition that significantly worsens health status. With half of those eligible now enrolled in a Medicare Advantage plan, policymakers are focused on assessing the clinical impact of the MA model on such diseases.
The spending on care for diabetes is significant at over $240 billion annually, with the Medicare program responsible for nearly 60% of that spending, according to the American Diabetes Association. And patients with diabetes typically have greater healthcare needs and higher spending leading up to their diagnoses.
WHAT'S THE IMPACT?
Avalere examined differences in Type 2 diabetes detection, treatment, outcomes and spending between matched patients in MA and fee-for-service (FFS) Medicare at three distinct disease phases: prediabetes; incident diabetes, in which someone is first diagnosed with type 2 diabetes; and chronic diabetes, when a patient has had Type 2 diabetes for more than one year.
Among patients with prediabetes who developed Type 2 diabetes, MA patients received a diagnosis earlier, relative to the date of the prediabetes diagnosis, than FFS patients. And MA patients had a lower diabetes severity score at diagnosis than FFS patients.
MA patients with incident diabetes were more likely than FFS patients to fill prescriptions for medications to treat diabetes and related conditions within the first year of diagnosis. Similarly high shares of MA and FFS patients filled prescriptions for blood pressure and cholesterol medications.
Of those with chronic diabetes, similarly high shares of MA and FFS patients visited primary care providers. But MA patients were more likely to receive preventive care, including diabetes-related office visits and testing for kidney disease, and they were less likely than FFS patients to require dialysis.
Out of those patients with prediabetes and diabetes, MA patients had fewer emergency department visits and hospital admissions. Both MA and FFS patients rarely had avoidable hospital admissions. Total medical spending was lower for MA patients. But among patients with diabetes, MA patients had higher diabetes-related spending than FFS patients.
Among dual eligible patients with diabetes – those who are enrolled in both Medicare and Medicaid – MA patients were more likely than FFS patients to visit a primary care provider and fill prescriptions for diabetes medications. Total medical spending was lower for these MA patients.
THE LARGER TREND
In addition to early detection, diabetes progression can be effectively managed through early and active pharmaceutical treatment. A 2020 meta-analysis of cost-effective treatments for diabetes found routine screening for diabetes and taking angiotensin-converting enzyme inhibitors to be cost-saving in managing hypertension and preventing kidney disease in patients with diabetes. This same study also found lipid-lowering medications, or statins, to be cost-effective in prevention of cardiovascular complications in patients with diabetes.
Care coordination and management also impact outcomes for patients with diabetes. Without proper management, adverse events such as amputations and kidney disease can occur more frequently. The Centers for Disease Control and Prevention reports that 85% of diabetes-related amputations could be prevented through routine healthcare services such as foot exams and patient education.
With half of those eligible now enrolled in MA plans, policymakers are focused on assessing the effectiveness of the MA model and understanding the differences in service use and outcomes in MA compared to FFS. MA enrollment more than doubled between 2012 and 2022, from 13.1 million to 29.1 million beneficiaries. The Medicare Trustees project that, by 2031, 53% of Medicare beneficiaries will be in an MA plan.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
