A new study has found that Medicare Advantage (MA) enrollees that require chronic disease management for diabetes have better health outcomes than individuals enrolled in Original Medicare.
Diabetes will often be detected earlier among Medicare Advantage recipients, who see the doctor sooner and receive more preventative care, which keeps them out of the emergency room in greater numbers than Original Medicare enrollees, according to the study by Avalere Health and the Better Medicare Alliance.
The results are important considering that nearly one-third of Americans over the age of 65 have Type 2 diabetes. Avalere decided to study the issue considering that about half of all Medicare recipients are enrolled in MA plans.
This news comes against the backdrop of a new law that took effect on Jan. 1 capping the out-of-pocket cost for insulin at $35 per month, without requiring them to first pay the Part D deductible, which amounts to $505 in 2023.
The main findings
Diabetes is a significant issue for seniors and the study found that overall MA beneficiaries on average had better outcomes for managing their diabetes. In particular, it found that:
- MA patients were diagnosed with type 2 diabetes more quickly than fee-for-service Medicare patients. It took on average 401 days from the prediabetes index date for MA patients to be diagnosed with type 2 diabetes, compared to 543 days for Original Medicare enrollees.
- MA enrollees were 15 percentage points more likely to have an evaluation and management visit in the first year of diagnosis.
- Prediabetes MA beneficiaries had 10% less average health care spending compared to prediabetes Original Medicare patients.
- MA beneficiaries had a 21% lower severity score when diagnosed with type 2 diabetes.
- MA beneficiaries were more likely to receive diabetes-related lab testing six months prior to diagnosis.
- Diabetic MA beneficiaries had fewer emergency department visits.
The conclusion
MA plans are administered by private insurers that contract with Medicare to offer their plans to seniors.
The study concludes that compared to Original Medicare, MA plans tend to focus on earlier diabetes detection and using more preventative care services, which can greatly reduce the need for emergency treatment and cut treatment expenditures, according to Mary Beth Donahue, president and CEO of the Better Medicare Alliance.
Many of these plans incentivize doctors in their networks to use these strategies to reduce overall costs and reduce the need for preventable services.
