Diabetes Outcomes Better for Patients Enrolled in MA Than FFS Medicare

Patients with type 2 diabetes (T2D) who were enrolled in Medicare Advantage (MA) had better outcomes compared with those in traditional Medicare, according to new research conducted by Avalere Health and funded by the Better Medicare Alliance.

“Nearly one third of people aged 65 and older have type 2 diabetes—a chronic condition that significantly worsens health status,” the study report said. “With half of those eligible now enrolled in a Medicare Advantage (MA) plan, policymakers are focused on assessing the clinical impact of the MA model on diseases such as diabetes.”

According to the study, patients with T2D enrolled in MA had higher prescription fill rates, lower rates of inpatient hospitalizations, fewer emergency department (ED) visits, and lower overall medical spending, compared with patients in traditional fee-for-service (FFS) Medicare.

The study also looked at differences between patients with prediabetes, incident diabetes, and chronic diabetes enrolled in MA vs FFS Medicare.

The report used FFS data from a 100% sample of Medicare Part A and Part B FFS claims and enrollment data and MA data from the MORE² Registry, as well as data from 2 large MA insurers.

As explained in the report, the index year for both incident and chronic T2D was the calendar year 2016, as well as a pre-index period of the prior 12 months and a 3-year follow-up between 2017 and 2019. Since prediabetes codes were new in 2017, the index year for the prediabetic cohort specifically was calendar year 2017 with a 12-month pre-index period and a 2-year post-index follow-up between 2018 and 2019. Continuous enrollment was required for the entire 12-month pre-period for all cohorts.

The report found that patients with prediabetes who developed T2D received an earlier diagnosis if they were enrolled in MA. For these patients, the average time between the prediabetes index date and T2D diagnosis was 401 days for patients under MA and 543 days for patients under FFS Medicare. According to medical claims used in this study, observed T2D prevalence during the 24-month follow-up period in patients with prediabetes was slightly higher in patients with MA (13%) compared with the matched sample of patients with FFS (11%).

Patients with prediabetes who developed T2D also had lower diabetes severity scores at the time of diagnosis if they were enrolled in MA. In this group, diabetes severity score at the time of diagnosis was 21% lower in patients with MA compared with matched patients with FFS Medicare (1.30 in MA vs 1.65 in FFS).

Patients with incident diabetes were more likely to fill prescriptions to treat diabetes and related conditions within the first year of receiving a T2D diagnosis if they were enrolled in MA than FFS Medicare. The report noted that similarly high shares of patients enrolled in MA and FFS Medicare filled their blood pressure and cholesterol medication prescriptions.

Among patients with chronic diabetes, similarly high shares of patients visited their primary care provider regardless of MA or FFS enrollment. Additionally, patients with MA were more likely to receive preventative care—including diabetes-related doctor visits and testing for kidney disease—but were less likely to require dialysis, compared with patients with FFS Medicare.

Among patients with prediabetes and diabetes—including incident and chronic diabetes—patients under MA had fewer ED visits and hospital admissions, but both groups rarely had avoidable hospital admissions. Additionally, patients under MA had lower total medical spending but, among patients with diabetes, patients enrolled in MA had higher diabetes-related spending than patients enrolled in FFS Medicare.

“The spending on care for diabetes is significant at over $240 billion annually, with the Medicare program responsible for nearly 60% of that spending,” the report added. “Additionally, patients with diabetes typically have greater healthcare needs and higher spending leading up to their diabetes diagnosis, highlighting the need to focus on treatment of patients with prediabetes and those at risk for diabetes.”

Among patients who were dual eligible for both Medicare and Medicaid, those with MA were more likely to visit a primary care provider and fill prescriptions for diabetes medications, and total medical spending was lower for these patients enrolled in MA compared with dual eligible patients enrolled in traditional Medicare.

As an observational study, this report has limits, such as the analysis being limited to the set of outcomes that are only observable in the claims. As such, other survey data, patient satisfaction, and labs were not available. The study also used a model to calculate spending for MA based on the spending from FFS data since actual health care spending is not observed in MA data. In addition, there was no insight into participation in advanced alternative payment models, which may make enhanced care coordination and management services available to providers.

“Findings from this study suggest that the care delivered to patients with prediabetes and type 2 diabetes in MA show patterns of care that are more indicative of early detection and active care management for patients than those experienced by similar patients in FFS,” the report concluded.

Reference

Avalere Health. Comparing detection, treatment, outcomes, and spending for patients with type 2 diabetes between Medicare Advantage and fee-for-service Medicare. Published January 10, 2023. Accessed January 20, 2023. https://bettermedicarealliance.org/wp-content/uploads/2023/01/Avalere-Diabetes-Progression-Whitepaper_1.10.23.pdf