Why Medicare Advantage plans should be prepared to adapt to the needs of ESRD patients

Medicare Advantage
A new analysis looks at key data on dually eligible end-stage renal disease patients for Medicare Advantage plans to track. (Getty/designer491)

Patients with end-stage renal disease (ESRD) are eligible to begin enrolling in Medicare Advantage (MA) plans starting next year. Insurers must be prepared to adapt to their needs, according to a new analysis. 

Researchers at Avalere compared cost and care utilization trends between dually eligible and non-duals in Pennsylvania and found that dually eligible beneficiaries with ESRD spend far more on hospitalizations and ambulance trips than Medicare beneficiaries do.  

Inpatient hospitalizations accounted for 23% of dual eligibles’ Medicare spending, compared to 20.8% for Medicare beneficiaries, while ambulance rides accounted for 1.9%.  

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By contrast, spending on visits to primary care physicians was on par when compared to non-duals. About 1.6% of Medicare spending for dual beneficiaries was for primary care, compared to 1.5% for non-duals.  

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Matt Kazan, principal at Avalere and one of the report’s authors, told Fierce Healthcare that highlights a significant opportunity for MA plans when these patients enroll, as greater use of primary care could prevent costly hospitalizations or ambulance rides. 

“Thinking about an order of priority and how we should invest, that seems to be backward,” Kazan said. “I would be starting to think about how I kind of rearrange the care delivery so that we don’t see those same things when we look at the MA data a couple of years from now.” 

The analysis also highlights the significant social needs of this population. Black patients accounted for 22% of Medicare beneficiaries with ESRD, while they accounted for 43% of dually eligible beneficiaries with renal disease. 

Just 12% of Pennsylvania’s overall population is Black making these findings even starker, the researchers said. 

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In addition, 4% of dually eligible beneficiaries were Hispanic, compared to 1% of Medicare beneficiaries, and 3% were Asian, compared to 1% of Medicare beneficiaries. Duals were also more likely to report food insecurity, housing insecurity and other significant social needs, according to the analysis.

Kazan said that ethnic health disparities linked to ESRD are not a new phenomenon, but marks another are that MA plans could offer interventions. This is especially true as MA insurers are gaining greater freedom to cover nonmedical services targeting social needs.

He said that as the COVID-19 pandemic further highlights longstanding health disparities, ESRD care is an area that’s ripe for innovation and improvement to better serve patients of color.

“This is a prime patient type and disease that renewed energy should be focused on,” he said. 

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