Study: Medicare Advantage beneficiaries less likely to get pricey diabetes treatments

Patients with diabetes on Medicare Advantage were more likely to get access to preventive treatments than their counterparts on traditional Medicare but were also less likely to get prescribed newer and more expensive treatments, a new study found. 

The study, published Thursday by the University of Pittsburgh School of Medicine, comes as enrollment in MA has swelled and scrutiny over care and risk adjustment practices has increased. 

“While MA plans enable greater access to preventative care, this may not translate to improved intermediate health outcomes,” the study said. “MA beneficiaries are also less likely to receive newer anti-hyperglycemic therapies with proven outcome benefits in high-risk individuals.”

The study looked at 345,911 Medicare beneficiaries enrolled in the Diabetes Collaborative Registry from 2014 to 2017, with 66% in fee-for-service beneficiaries and 34% in MA plans.

It found that MA plan holders were more likely than traditional, fee-for-service Medicare to get access to key preventive measures. This includes screening for the eye disease retinopathy, where 59% of MA beneficiaries were screened for it compared to 55% on traditional Medicare. 

MA beneficiaries were also more likely to get screenings for foot care and the deterioration of kidney functions. 

However, only 6.9% of MA beneficiaries received a treatment called glucagon-like peptide-1 (GLP-1) receptor agonists compared with 9% for traditional Medicare. GLP-1 agonists are newer treatments aimed at reducing blood sugar levels.

Those on MA plans were also less likely (5.4% to 6.7%) to get sodium-glucose cotransporter-2 (SGLT2) inhibitors, which are also used to lower blood sugar.

The study couldn’t specifically pinpoint why MA beneficiaries were less likely to gain access to the newer treatments.

“We controlled for—as much as we could—for people who had access to in terms of clinical factors and region that the patients were coming from and what type of doctor they were seeing and socioeconomic factors,” said Utibe Essien, M.D., assistant professor of medicine at the University of Pittsburgh and lead author in the study, in an interview with Fierce Healthcare.

The findings come as MA enrollment is expected to outpace traditional Medicare, and data have shown 1 in 5 Medicare beneficiaries has diabetes. 

MA plans are run by private insurers and offer access to more benefits than traditional Medicare such as dental or vision. The plans, in turn, rely on specific networks and formulary management tools such as step therapy or prior authorization to help rein in costs. 

But the study authors said regulators need to explore the incentives for MA plans. 

While traditional Medicare spends more per-beneficiary on diabetes than MA, “patients with diabetes enrolled in MA had slightly higher measures of blood pressure, lipids and glycemia, suggesting that a better understanding is needed of the role of such incentives in this patient population,” the study said.

The authors noted the study has some limitations that include the Diabetes Collaborative Registry is voluntary, limiting how general the findings could be. 

Nevertheless, study authors note that the findings “reinforce the need for surveillance of long-term outcomes under various Medicare plan structures. Identifying strategies to ensure equitable access to high-quality diabetes care across population segments remains a high priority.”

The study comes as lawmakers are pressing the Centers for Medicare & Medicaid Services to take a longer look at risk adjustment tactics employed by some MA plans such as using chart reviews and health risk assessments to inflate beneficiary risk scores and garner higher payments from Medicare.

A recent analysis from the Department of Health and Human Services’ Office of Inspector General also found that at times MA plans have delayed or denied beneficiary access to care, although industry groups counter the analysis is focused on a small subset of claims. 

The MA advocacy group Better Medicare Alliance has pushed back on the criticism, pointing to high patient satisfaction rates and research on lower rates of avoidable hospitalizations compared with traditional Medicare.