Diabetic patients with Medicare benefit plans more likely to have poorer health, study finds

image: Utibe Essien, MD, MPH
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Credit: University of Pittsburgh

PITTSBURGH, July 7, 2022 – While patients with diabetes on the Medicare Advantage plan are more likely to receive preventative care, they are less likely to be prescribed new, more expensive drugs and more likely to have high blood pressure and poorer blood glucose control than patients on the Cost plan Medicare-For-Services, according to a new study led by physician-scientists at the University of Pittsburgh School of Medicine.

The study, published today in Diabetes Treatment, raised the red flag that – despite increasing access to preventative care – rapid growth in Medicare Advantage registrants could signal a trend toward poorer health outcomes and gaps in care when compared to their Medicare Fee-For-Service counterparts.

“Preventive care is not enough to prevent patients from utilizing the healthcare system in the future,” said lead author Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the VA Pittsburgh Healthcare System. “We need to make sure the right patients get the right treatment, possibly a combination of preventive and therapeutic interventions.”

Diabetes is reported in 1 in 5 Medicare recipients aged 65 and older and is associated with more than 60% higher out-of-pocket prescription costs compared to those without diabetes.

The researchers used data from more than 5,000 physicians participating in The Diabetes Collaborative Registry to study nearly 350,000 patients with type 2 diabetes aged 65 years or older on a Medicare Advantage or Medicare Fee-For-Service plan. They compared metrics of quality, preventive care and prescribing patterns between the two groups.

The study found that patients with Medicare Advantage were more likely to receive preventive care, such as tobacco cessation, foot care and other screenings. However, patients on the Medicare Advantage plan were also more likely to have high blood pressure and poorer diabetes control, and were less likely to receive newer evidence-based medications than their counterparts on the Medicare Fee-For-Service plan. Medicare Advantage uses a variety of strategies to reduce treatment costs, including limiting access to newer and more expensive drugs.

Older generic diabetes medications, such as angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), are appropriately prescribed to Medicare Advantage beneficiaries. But when it comes to newer, more expensive drugs — such as peptide-1 receptor agonists such as glucagon (GLP-1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i) — Essien says, “We saw a clear decline in Medicare Advantage registrants. get those drugs, despite strong evidence that they benefit diabetic patients by reducing kidney disease, cardiovascular disease, and mortality.”

“With Medicare Advantage plans continuing to grow rapidly and now covering nearly half of all Medicare recipients, these data require ongoing monitoring of long-term health outcomes under various Medicare plans,” said senior author Muthiah Vaduganathan, MD, MPH, co-director of Center for Implementation Science and staff cardiologists at Brigham and Women’s Hospital and Harvard Medical School.

The researchers hope that these findings can help refine the Medicare Advantage program, enabling patients to access the care and treatment they need while keeping healthcare costs and utilization low.

“Given the increasing risk factors for diabetes among Americans, we will see an increase in the number of Medicare Advantage registrants who need high-quality diabetes care,” Essien said. “I am a general internist – my primary focus is on prevention – but our data shows that is not enough.”

Additional authors on the study are Yuanyuan Tang, Ph.D., Fengming Tang, MS, Philip G. Jones, MS, and Mikhail N. Kosiborod, MD, all from the St. Central American Heart Institute. Luke; Jose F. Figueroa, MD, MPH, of Harvard University; Terrence Michael A. Litam, MHA, of the VA Pittsburgh Healthcare System; Ravi Patel, MD, M.Sc., of Northwestern University; Rishi K. Wadhera, MD, MPP, M. Phil., of Beth Israel Deaconess Medical Center; Nihar R. Desai, MD, MPH, from Yale University; and Sanjeev N. Mehta, MD, MPH, of the Joslin Diabetes Center.

The research was conducted within The Diabetes Collaborative Registry, which was established with financial support from AstraZeneca and Boehringer Ingelheim. The authors list their individual grant endorsements and disclosures in the Diabetes Care manuscript.

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About the University of Pittsburgh Fakultas School of Medicine

As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a wide range of disciplines in an ongoing effort to harness the power of new knowledge and improve the human condition. Driven primarily by the School of Medicine and its affiliates, Pitt has been ranked among the top recipients of grants from the National Institutes of Health since 1998. In the rankings released by the National Science Foundation, Pitt is in the upper echelon of all American universities in total research and development support. federal science and engineering.

Likewise, the School of Medicine shares a shared commitment to advancing the quality and strength of medical and postgraduate education programs, being recognized as innovative leaders, and to training highly skilled, compassionate doctors and creative scientists who are well equipped to engage in classroom research. world. The School of Medicine is an academic partner of UPMC, who has worked closely with the University to raise the bar for medical excellence in Pittsburgh and position healthcare as the driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu.

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