A new white paper finds earlier detection, greater utilization of preventive care, and fewer inpatient hospitalizations and emergency room visits among Medicare Advantage (MA) beneficiaries with diabetes compared to fee-for-service (FFS) Medicare beneficiaries with diabetes.
MA may provide higher quality and more cost-effective care to beneficiaries with diabetes compared to FFS Medicare, according to a new study conducted by Avalere Health and commissioned by Better Medicare Alliance, a research and advocacy organization that supports MA. These types of studies are important to understand beneficiaries’ experience across the Medicare program, said Tom Kornfield, senior consultant at Avalere Health.
Nearly one-third of people aged 65 and older have type 2 diabetes and half of those eligible are now enrolled in a MA plan. In the study, Avalere examined differences in type 2 diabetes detection, treatment, outcomes, and spending between matched patients in MA and FFS Medicare at three distinct disease phases: prediabetes, when a patient has a prediabetes diagnosis; incident diabetes, when a patient is first diagnosed with type 2 diabetes; and chronic diabetes, when a patient has had type 2 diabetes for more than one year. The study found:
- MA patients with diabetes have better outcomes on certain measures, including higher prescription fill rates, lower rates of inpatient hospitalizations, fewer emergency department visits, and lower total medical spending as compared to similar diabetes patients enrolled in FFS Medicare.
- Patients with prediabetes who developed type 2 diabetes received their diagnosis earlier (relative to when they were diagnosed with prediabetes) in MA than FFS Medicare and had a lower diabetes severity score. MA patients also had fewer emergency department visits and hospital admissions than FFS patients. Both MA and FFS patients rarely had avoidable hospital admissions, and total medical spending was lower for MA patients than FFS patients. However, among patients with diabetes, MA patients had higher diabetes-related spending than FFS patients.
- MA beneficiaries with chronic diabetes more frequently received testing for kidney disease and required dialysis less frequently than those enrolled in FFS Medicare.
- Among dual eligible patients with diabetes (patients 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 than these FFS patients.
“With nearly one-third of seniors who have a type 2 diabetes diagnosis, this study shows how Medicare Advantage is already at work engaging the unique needs of this beneficiary population, focusing on earlier detection and greater use of preventive care, resulting in fewer hospitalizations and lower total medical spending, and creating better opportunities to age with vitality and independence for all seniors who live with this condition compared to FFS Medicare,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance, in the study announcement. “Policymakers and advocates should look to this report as a reminder of the importance of protecting Medicare Advantage, which enables this care management that is demonstrably improving outcomes for Medicare beneficiaries with diabetes.”