Medicare Advantage Patients Get More Secondary Care with Same Outcomes than Fee-for-Service

Patients with coronary artery disease (CAD) enrolled in Medicare Advantage (MA) are more likely to receive evidence-based secondary prevention versus fee-for-service (FFS) Medicare, but this did not necessarily translate to better outcomes, according to findings published in JAMA Cardiology.

Medicare Advantage represents Medicare’s managed care alternative to the tradition FFS model, and as of 2017, covers 33% of Medicare recipients, increased from 22% in 2008. Although limited data previously existed on actual clinical outcomes, studies of administrative claims data suggest that MA enrollees receive higher-quality care than FFS recipients, with advocates of MA contending this is due to MA plans providing access to additional support in the form of disease management and coaching.

Additionally, proponents claim that since MA plans are required to yield quality data to Medicare while receiving bonuses for high performance, they possess a financial interest in following evidence-based guidelines and achieving enhanced outcomes. The study authors aimed to determine the differences, if any, in evidence-based secondary prevention treatments between the two groups of beneficiaries. In this observational, retrospective, cohort study, researchers identified 35,563 patients enrolled in MA, and 172,732 registered in FFS. All patients were 18 years or older, and diagnosed with CAD between January 1, 2013, and May 1, 2014, at cardiology practices participating in the Practice Innovation and Clinical Excellence (PINNACLE) registry. Of all observed patients enrolled in MA, 56.8% (20,193) were male (mean age, 76.7) compared to 57.9% (100,0255) male in the FFS cohort (mean age, 77.5).  Data was collected and analyzed from March to July 2018.

Differences in Secondary Care, Not Outcomes

Compared to FFS beneficiaries, MA enrollees were younger, more likely to be both non-white and female, and more likely to have heart failure (HF), diabetes, and chronic kidney disease (CKD). Moreover, MA patients were more likely to receive secondary prevention treatments, such as beta-blockers (80.6% vs. 78.8%; P<0.001), angiotensin II receptor blockers (70.7% vs. 65.1%; P<0.001), and statins (68.4% vs. 64.5%; P<0.001), and more likely to receive all three when eligible. Following adjustment, researchers uncovered that MA beneficiaries had greater odds of receiving guideline-recommended therapy compared to those enrolled in FFS for beta-blockers (OR=1.10; CI, 1.04 to 1.17), angiotensin II receptor blockers (OR=1.13; 95% CI, 1.08 to 1.19), and all three medications (OR=1.23; 95% CI, 1.01 to 1.50). However, no appreciable differences were reported in intermediate outcomes between those enrolled in the two plans, including systolic and diastolic blood pressure and low-density lipoprotein cholesterol levels.

The researchers concluded that among CAD patients, MA beneficiaries suffer more comorbidities than FFS members, and are more likely to be administered secondary treatments. These results, the authors wrote, suggest that MA plans “may drive improvements in process-based quality measures for Medicare beneficiaries, although this may have a limited effect on improving patient outcomes over FFS Medicare.”

Using the PINNACLE registry, we find that MA patients were more likely to receive evidence-based secondary prevention than FFS patients. However, no meaningful difference in LDL levels or blood pressure. @JAMACardio https://t.co/71CGRwS3vf pic.twitter.com/KwGBxTT5cI

— Jose Figueroa, MD, MPH (@joefigs2) February 20, 2019

Differences in Management of Coronary Artery Disease in Patients With Medicare Advantage vs Traditional Fee-for-Service Medicare Among Cardiology Practiceshttps://t.co/K2QZI6fAU3

— BIOCIENCIA (@BIOCIENCIA2013) February 23, 2019

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