BMA: Medicare Advantage outperforms fee-for-service on certain diabetes outcomes

Medicare Advantage (MA) patients perform better compared to traditional fee-for-service Medicare on some diabetes outcomes including earlier diagnosis, according to a new analysis. 

The analysis, published Tuesday the consulting firm Avalere Health (PDF) and commissioned by advocacy group Better Medicare Alliance (BMA), comes amid questions over high spending and marketing practices in MA. 

“The study finds that several measures indicative of positive management of diabetes were higher for those in Medicare Advantage than those in traditional Medicare,” said Tom Kornfield, Avalere senior consultant, in a statement. “Studies like this one are important to understand beneficiaries’ experiences across the Medicare program.”

Diabetes is very prevalent among seniors, and spending on the condition can go over $240 billion a year, with Medicare responsible for 60% of that spending, the report said. Such patients usually have high related spending on other conditions as well. 

MA has become a massively popular option for seniors and is expected to comprise more than half of total Medicare enrollment in 2023. 

Researchers looked at fee-for-service data from Medicare Part A and B claims and identified beneficiaries who have prediabetes, get their first diagnosis and suffer chronic diabetes for more than one year. The analysis then compared both MA and fee-for-service outcomes on more than 20 measures. 

It found that patients who had prediabetes that eventually developed Type 2 got diagnosed earlier in MA. The average time between a prediabetes date and the diagnosis of Type 2 was 401 days for MA compared with 543 for traditional Medicare.

MA patients were also more likely to get their medications for diabetes and for related heart issues. In the first nine months after getting diagnosed, 46% of MA patients filled their prescriptions compared to 35% in traditional Medicare.

Those in MA also got more tests to detect related conditions like early signs of kidney damage. Such patients took a urine test at a slightly higher rate than traditional Medicare for finding kidney damage. 

Avalere found that the use of advance technology such as remote monitoring was rare among both MA and fee-for-service. However, Patients in MA were twice as likely to use such technologies such as pumps or monitoring systems than fee-for-service. 

MA patients also had slightly fewer emergency department and hospital admissions compared with fee-for-service.

Even though overall some of the differences between MA and traditional Medicare were modest, “the size of the affected population (people with Type 2 diabetes in Medicare) indicates that even small differences at an individual patient level may translate to meaningful differences in population-level health outcomes and aggregate Medicare spending,” the analysis said. 

MA’s effect on overall Medicare spending has been the subject of increased scrutiny in recent years. Some critics have charged that MA plans have used tools such as chart reviews and health risk assessments to game risk adjustment methodology and get a higher quality score/bonus from Medicare. 

The study comes as BMA has said that MA is delivering better health outcomes and better care than fee-for-service. 

A September 2022 report from the Kaiser Family Foundation showed that MA beneficiaries were more likely than fee-for-service to get preventive services like routine checkups and immunizations. However, traditional Medicare beneficiaries were more likely to get care in the highest-rated hospitals, and satisfaction rates were similar between MA and traditional Medicare.

The program has also received congressional scrutiny of its marketing practices. A Senate report from last year showed that some states are seeing a rise in complaints of aggressive and misleading marketing from plan brokers and agents.