TY - JOUR
T1 - Diabetes care among older adults enrolled in medicare advantage versus traditional medicare fee-for-service plans
T2 - The diabetes collaborative registry
AU - Essien, Utibe R.
AU - Tang, Yuanyuan
AU - Figueroa, Jose F.
AU - Litam, Terrence Michael A.
AU - Tang, Fengming
AU - Jones, Philip G.
AU - Patel, Ravi
AU - Wadhera, Rishi K.
AU - Desai, Nihar R.
AU - Mehta, Sanjeev N.
AU - Kosiborod, Mikhail N.
AU - Vaduganathan, Muthiah
N1 - Funding Information:
Funding. U.R.E. has received grant support from the Department of Veterans Affairs Health Services Research and Development Division (CDA-20-049). J.F.F. has received grant support from the National Institutes of Health National Center for Advancing Translational Sciences (KL2TR002542) and the Commonwealth Fund. R.P. reports support from the National Institutes of Health National Center for Advancing Translational Sciences (KL2TR001424). R.K.W. reported receiving research support from the National Institutes of Health National Heart, Lung, and Blood Institute (grant K23HL148525-1).
Publisher Copyright:
© 2022 by the American Diabetes Association
PY - 2022/7
Y1 - 2022/7
N2 - OBJECTIVE Medicare Advantage (MA), Medicare’s managed care program, is quickly expanding, yet little is known about diabetes care quality delivered under MA compared with traditional fee-for-service (FFS) Medicare. RESEARCH DESIGN AND METHODS This was a retrospective cohort study of Medicare beneficiaries ≥65 years old enrolled in the Diabetes Collaborative Registry from 2014 to 2019 with type 2 diabetes treated with one or more antihyperglycemic therapies. 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%) inMA plans (for ≥1month).MA beneficiaries were more likely to receive ACE inhibitors/angiotensin receptor blockers for coronary artery disease, tobacco cessation counseling, and screening for retinopathy, foot care, and kidney disease (adjusted P # 0.001 for all). MA beneficiaries had modestly but significantly higher systolic blood pressure (+0.2 mmHg), LDL cholesterol (+2.6 mg/dL), and HbA1c (+0.1%) (adjusted P 0.01 for all). MA beneficiaries were independently less likely to receive glucagon-like peptide 1 receptor agonists (6.9% vs. 9.0%; adjusted odds ratio 0.80, 95% CI 0.77–0.84) and sodium–glucose cotransporter 2 inhibitors (5.4% vs. 6.7%; adjusted odds ratio 0.91, 95% CI 0.87–0.95).When integrating Centers for Medicare and Medicaid Services-linked data from 2014 to 2017 and more recent unlinked data from the Diabetes Collaborative Registry through 2019 (total N 5 411,465), these therapeutic differences persisted, including among subgroups with established cardiovascular and kidney disease. CONCLUSIONS While MA plans enable greater access to preventive 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.
AB - OBJECTIVE Medicare Advantage (MA), Medicare’s managed care program, is quickly expanding, yet little is known about diabetes care quality delivered under MA compared with traditional fee-for-service (FFS) Medicare. RESEARCH DESIGN AND METHODS This was a retrospective cohort study of Medicare beneficiaries ≥65 years old enrolled in the Diabetes Collaborative Registry from 2014 to 2019 with type 2 diabetes treated with one or more antihyperglycemic therapies. 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%) inMA plans (for ≥1month).MA beneficiaries were more likely to receive ACE inhibitors/angiotensin receptor blockers for coronary artery disease, tobacco cessation counseling, and screening for retinopathy, foot care, and kidney disease (adjusted P # 0.001 for all). MA beneficiaries had modestly but significantly higher systolic blood pressure (+0.2 mmHg), LDL cholesterol (+2.6 mg/dL), and HbA1c (+0.1%) (adjusted P 0.01 for all). MA beneficiaries were independently less likely to receive glucagon-like peptide 1 receptor agonists (6.9% vs. 9.0%; adjusted odds ratio 0.80, 95% CI 0.77–0.84) and sodium–glucose cotransporter 2 inhibitors (5.4% vs. 6.7%; adjusted odds ratio 0.91, 95% CI 0.87–0.95).When integrating Centers for Medicare and Medicaid Services-linked data from 2014 to 2017 and more recent unlinked data from the Diabetes Collaborative Registry through 2019 (total N 5 411,465), these therapeutic differences persisted, including among subgroups with established cardiovascular and kidney disease. CONCLUSIONS While MA plans enable greater access to preventive 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.
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U2 - 10.2337/dc21-1178
DO - 10.2337/dc21-1178
M3 - Article
C2 - 35796766
AN - SCOPUS:85134360785
SN - 1935-5548
VL - 45
SP - 1549
EP - 1557
JO - Diabetes Care
JF - Diabetes Care
IS - 7
ER -
