Medicare Advantage Beneficiaries Have Better Diabetes Patient Outcomes

January 12, 2023 - Medicare Advantage plans have seen better patient outcomes in chronic disease management for diabetes than fee-for-service Medicare, according to a study by Avalere.

“Medicare Advantage is increasingly popular among Medicare beneficiaries. Given the program’s rising enrollment and the high incidence of diabetes among Medicare beneficiaries, our study focused on how enrollees with diabetes in Medicare Advantage compare to similar enrollees in fee-for-service Medicare,” Tom Kornfield, senior consultant at Avalere Health, said about the study in a Better Medicare Alliance press release.

“The study finds that several measures indicative of positive management of diabetes were higher for those in Medicare Advantage than those in traditional Medicare. Studies like this one are important to understand beneficiaries’ experiences across the Medicare program.”

The study relied on Medicare Part A and Part B Medicare fee-for-service claims and enrollment data, while the Medicare Advantage data came from the MORE Registry and additional data from two large payers in the Medicare Advantage space.

The prediabetes cohort consisted of over 198,500 Medicare Advantage members and the same number of fee-for-service Medicare beneficiaries. The incident type 2 diabetes cohort included almost 162,500 Medicare Advantage enrollees and an equal share of fee-for-service beneficiaries. The chronic type 2 diabetes cohort was over 1.1 million enrollees strong in Medicare Advantage and the same number for fee-for-service beneficiaries.

READ MORE: Tracking the Results of Medicare Advantage Marketing Policies Remains a Challenge

Researchers assessed 20 outcome measures across disease detection and severity at diagnosis, primary care provider visits, prescriptions and tests, healthcare spending, and acute care utilization. The study timeframe was 42 months long for participants with diabetes and 30 months long for participants with prediabetes, including the six months pre-index date. Researchers analyzed outcomes in six-month increments throughout that time.

The study found that, pre-index, prediabetes Medicare Advantage beneficiaries had 10 percent lower average healthcare spending per patient per year compared to prediabetes fee-for-service Medicare patients. In the first one to two years post-index, Medicare Advantage patients’ healthcare spending was 13 percent lower than their fee-for-service counterparts.

The incident diabetes cohort Medicare Advantage beneficiaries’ spending was lower. The same was true in the chronic diabetes cohort where, pre-index, healthcare spending was 20 percent lower for Medicare Advantage beneficiaries than fee-for-service Medicare beneficiaries.

However, in both the incident cohort and the chronic diabetes groups, the gap between Medicare Advantage and fee-for-service beneficiaries’ healthcare spending shrank over time.

Medicare Advantage patients were diagnosed with type 2 diabetes more quickly than fee-for-service Medicare patients. It took on average 401 days from the prediabetes index date for Medicare Advantage patients to be diagnosed with type 2 diabetes. On average, fee-for-service beneficiaries had to wait an additional 142 days for their diagnosis.

READ MORE: OIG: Cigna Should Refund Feds $5.9M for Medicare Advantage Overpayments

Medicare Advantage beneficiaries also had a 21 percent lower severity score when diagnosed with type 2 diabetes. They were also more likely than fee-for-service Medicare beneficiaries to receive diabetes-related lab testing in the incident cohort in the six months prior to diagnosis. Medicare Advantage beneficiaries were 9 percentage points more likely to receive an A1C test in the 12 months pre-index.

In the incident cohort, Medicare Advantage enrollees were 15 percentage points more likely to have an evaluation and management visit in the first year post-index. Post-diagnosis, they were also more likely to be tested for complicating conditions like microalbuminuria.

Medicare Advantage beneficiaries had higher rates of filled prescriptions for insulin in the nine months after diagnosis than fee-for-service beneficiaries across a couple of types of medications.

Emergency department visits were lower for Medicare Advantage patients than for fee-for-service Medicare beneficiaries. The gap between the rate of emergency department visits for Medicare Advantage and fee-for-service Medicare patients with prediabetes and chronic diabetes grew in the months following their diabetes diagnoses.

“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,” Mary Beth Donahue, president and chief executive officer of the Better Medicare Alliance, said in the Better Medicare Alliance press release.

READ MORE: Traditional Medicare to Medicare Advantage Switching Rates Grew in 2020

Some metrics were similar between the two cohorts. For example, primary care visit rates were similar between Medicare Advantage and fee-for-service Medicare beneficiaries. Inpatient hospitalization rates for the prediabetes cohort were similar.

“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,” Donahue added.

Separate studies have found that Medicare Advantage and traditional Medicare beneficiaries report similar patient satisfaction rates. Additional research has indicated that mental healthcare coverage is lagging in Medicare Advantage.