Most Medicare Dual-Eligibles See Social Determinants of Health

May 29, 2019 - Over half of dual-eligible Medicare Advantage beneficiaries experience the social determinants of health, revealing a need for better social health programming within the program, according to data presented by Avalere at ISPOR 2019.

The data, which included administrative claims, CMS data, and other data linked with zip-code level information for nearly 2 million beneficiaries, revealed that more vulnerable Medicare beneficiaries yield poorer outcomes. Specifically, these members have poorer health, higher utilization rates, higher healthcare spending, and lower quality measure scores.

The researchers looked at the socioeconomic status of dual-eligible members, or members who qualify for both Medicare and Medicaid.

While dual-eligible benefits usually vary by state, it tends to be a marker of extreme health need. Patients receiving both Medicare and Medicaid benefits usually have high complex health needs, which is why they need access to both social safety nets.

More dual-eligibles fell into populations that have traditionally been regarded as vulnerable. One-third of duals were under the age of 65, meaning they needed access to Medicare before the age at which most beneficiaries join the program.

Duals were also more likely to be female, a part of a racial or ethnic minority, or living in a rural region, compared to their non-dual eligible counterparts.

As a result, more dual-eligible beneficiaries experienced social determinants of health than non-duals. More than half of duals lived in a neighborhood where the median income was $30k. This is compared to only 16 percent of non-duals that experienced the same

Fifty-five percent of full duals lived in a neighborhood where at least 20 percent of its inhabitants lived below the federal poverty level, whereas 39 percent of partial duals and 19 percent of non-duals reported the same.

Finally, dual-eligibles reported lower educational attainment, a key social determinant of health. Duals were more likely to live in a neighborhood where fewer than 20 percent of its inhabitants had a bachelor’s degree or higher. Forty-seven percent of partial-duals and 37 percent of non-duals reported such, whereas 64 percent of dual-eligible beneficiaries said the same.

These social determinants of health were tied to certain health outcomes. Dual-eligible beneficiaries were more likely to have a chronic illness than were their non-dual eligible peers.

Dual-eligibles were more likely to have hypertension, diabetes, rheumatoid arthritis, depression, chronic kidney disease, asthma, chronic obstructive pulmonary disease (COPD), heart failure, osteoporosis, stroke, and Alzheimer’s disease or dementia.

Non-duals were more likely to have hyperlipidemia, eye disease, and hyperthyroidism.

Furthermore, dual-eligible beneficiaries utilized the healthcare system more frequently than non-dual eligibles. Duals used the emergency department three times as often as non-duals, refilled their prescription drugs twice as often, and were hospitalized 1.8 times as often. They also had 1.5 times the outpatient visits as non-duals.

Healthcare spending was higher for dual-eligible beneficiaries, reaching up to nearly three times the spending on non-duals for some services.

Specifically, Medicare Part D spending was 2.7 times higher for dual-eligibles while spending on durable medical devices was 2.8 times higher. Dual eligibles saw hospital inpatient utilization spending that was 1.5 times higher than it was for non-duals, and physician service spending that was 1.3 times higher.

Dual-eligible beneficiaries also had lower quality measure scores, including a 70 percent greater use of high-risk medications and 18 percent higher rate of potentially avoidable hospitalizations.

These results reveal just how expensive dual-eligible beneficiaries are, the researchers pointed out. While these patients may genuinely need the coverage, more must be done to prevent the occurrence of high-cost encounters.

Programs that address the social determinants of health may specifically help reduce ED visits, the use of multiple medications, and avoidable hospitalizations. To design these programs, industry leaders must gain a better understanding of the specific social needs of high-risk members, the researchers concluded.