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Diabetes Care Among Older Adults Enrolled in Medicare Advantage versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry

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posted on 2022-07-07, 00:10 authored by Utibe R. Essien, Yuanyuan Tang, Jose F. Figueroa, Terrence Michael A. Litam, Fengming Tang, Philip G. Jones, Ravi Patel, Rishi K. Wadhera, Nihar R. Desai, Sanjeev N. Mehta, Mikhail N. Kosiborod, Muthiah Vaduganathan

Objective: Medicare Advantage (MA), Medicare’s managed care program, is quickly expanding, yet little is known about diabetes care quality delivered under MA compared to traditional Fee-for-Service (FFS) Medicare.

Research Study and Methods: Retrospective cohort study of Medicare beneficiaries ≥65 years-old enrolled in the Diabetes Collaborative Registry from 2014-2019 with type 2 diabetes treated with ≥1 antihyperglycemic therapy. Quality measures, cardiometabolic risk factor control, and antihyperglycemic prescription patterns were compared between Medicare plan groups, adjusted for sociodemographic and clinical factors.

Results: Among 345,911 Medicare beneficiaries, 229,598 (66%) were enrolled in FFS and 116,313 (34%) in MA plans (for ≥1-month). MA beneficiaries were more likely to receive ACEi/ARBs for coronary artery disease, tobacco cessation counseling, and screening for retinopathy, foot care, and nephropathy (adjusted P≤0.001 for all). MA beneficiaries had modestly, but significantly higher systolic BP (+0.2mmHg), LDL-c (+2.6 mg/dL), and HbA1c (+0.1%) (adjusted P<0.01 for all). MA beneficiaries were independently less likely to receive GLP-1RA (6.9% vs. 9.0%; adjusted OR 0.80, 95% CI 0.77-0.84) and SGLT2i (5.4% vs. 6.7%; adjusted OR 0.91, 95% CI 0.87-0.95). When integrating CMS-linked data from 2014-2017 and more recent unlinked data from DCR through 2019 (total n=411,465), these therapeutic differences persisted, including among subgroups with established cardiovascular and kidney disease.

Conclusions: While MA plans enable greater access to preventative care, this may not translate to improved intermediate health outcomes. MA beneficiaries are also less likely to receive newer antihyperglycemic therapies with proven outcome benefits in high-risk individuals. Long-term health outcomes under various Medicare plans requires surveillance. 

Funding

The Diabetes Collaborative Registry (DCR) was formed by the American College of Cardiology, the American Diabetes Association, the American College of Physicians, the American Association of Clinical Endocrinologists, and the Joslin Diabetes Center, with funding support by AstraZeneca and Boehringer Ingelheim.

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