Diabetes patients on Medicare advantage plans more likely to have worse health, study finds

PITTSBURGH, July 7, 2022 – While patients with diabetes on Medicare Advantage plans are more likely to receive preventive treatments, they were less likely to be prescribed newer, more expensive medications and were more likely to have higher blood pressure and worse blood glucose control than patients on Medicare Fee-For-Service plans, according to a new study led by a University of Pittsburgh School of Medicine physician-scientist.  

The study, published today in Diabetes Care, raises a red flag that – despite improving access to preventive care – the rapid growth in Medicare Advantage enrollees may foreshadow a trend toward poorer health outcomes and disparities in care when compared with their Medicare Fee-For-Service counterparts.  

“Preventive treatments are not enough to keep patients from utilizing the health care system down the road,” said lead author Utibe Essien, M.D., M.P.H., 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 are getting the right treatment, likely a combination of preventive and therapeutic interventions.” 

Diabetes is reported in 1 in 5 Medicare beneficiaries age 65 and older and is associated with over 60% higher out-of-pocket prescription costs compared to those without diabetes.  

The researchers used data from more than 5,000 clinicians who participate in The Diabetes Collaborative Registry to study nearly 350,000 patients with Type 2 diabetes aged 65 or older on Medicare Advantage or Medicare Fee-For-Service plans. They compared quality metrics, preventive care and prescription patterns between the two groups.  

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

Older, generic diabetes medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), were appropriately prescribed to the Medicare Advantage beneficiaries. But when it came to newer, more expensive medications – such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i) – Essien said, “We saw a clear drop in Medicare Advantage enrollees getting those medications, despite unequivocal evidence that they benefit patients with diabetes by reducing kidney disease, cardiovascular disease and death.” 

“With Medicare Advantage plans continuing to rapidly expand and now covering nearly half of all Medicare beneficiaries, these data call for ongoing surveillance of long-term health outcomes under various Medicare plans,” said senior author Muthiah Vaduganathan, M.D., M.P.H., co-director of the Center for Implementation Science and staff cardiologist at Brigham and Women’s Hospital and Harvard Medical School.  

The researchers hope that these findings can help fine-tune the Medicare Advantage program, allowing patients to access the care and treatments they need while keeping costs and health care utilization low. 

“Given the rising risk factors for diabetes among Americans, we’re going to see increasing numbers of Medicare Advantage enrollees needing high-quality diabetes care,” Essien said. “I’m a general internist – my primary focus is on prevention – but our data suggest that is not enough.” 

Additional authors on this study are Yuanyuan Tang, Ph.D., Fengming Tang, M.S., Philip G. Jones, M.S., and Mikhail N. Kosiborod, M.D., all of St. Luke’s Mid America Heart Institute; Jose F. Figueroa, M.D., M.P.H., of Harvard University; Terrence Michael A. Litam, M.H.A., of the VA Pittsburgh Healthcare System; Ravi Patel, M.D., M.Sc., of Northwestern University; Rishi K. Wadhera, M.D., M.P.P., M.Phil., of Beth Israel Deaconess Medical Center; Nihar R. Desai, M.D., M.P.H., of Yale University; and Sanjeev N. Mehta, M.D., M.P.H., of the Joslin Diabetes Center.  

This research was conducted within The Diabetes Collaborative Registry, which was established with funding support by AstraZeneca and Boehringer Ingelheim. The authors listed their individual grant support and disclosures in the Diabetes Care manuscript.  

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About the University of Pittsburgh 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 broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top recipients of funding from the National Institutes of Health since 1998. In rankings released by the National Science Foundation, Pitt is in the upper echelon of all American universities in total federal science and engineering research and development support. 

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu. 

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