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BACKGROUND Community-level social determinants of health and economic distress explain some disparities in health service utilization and outcomes among older Medicare fee-for-service (FFS) enrollees. 1 Medicare-covered and recommended preventive and care coordination services-including flu vaccines, annual wellness visits (AWVs), transitional care management (TCM), and advance care planning (ACP) visits-may improve outcomes and reduce spending, 2, 3 but uptake of these services has been slow, 4, 5 particularly among the disenfranchized. 5

Background: While overall Medicare Part C (Medicare Advantage) enrollment has grown more rapidly than fee-for-service Medicare enrollment, changes in the growth and characteristics of different enrollee populations have not been examined. Objectives: For 2011-2019, to compare changes in the growth and characteristics of younger (age younger than 65) and older (age 65 and older) Medicare beneficiaries enrolled in Medicare Part A only, Medicare Parts A & B, and Medicare Part C.

DO, MS patient across time. The CCDW algorithms use different numbers of sequential years, or lookback periods, to flag different conditions. We hypothesized that flags based on longer lookback periods (eg, 3 years for Alzheimer disease) and used for conditions unlikely to be cured (eg, schizophrenia) would be more likely to persist in the same patient than flags based on shorter lookback periods (eg, 1 year for anemia) and conditions with high cure rates (eg, hip and pelvic fracture). MethodsThe Solutions IRB institutional review board and the Centers for Medicare & Medicaid Services approved this cross-sectional study. They determined that informed consent was not required because Medicare enrollees consent to research analysis of their claims data on enrollment and because retroactive collection of informed consent from millions of patients would be impractical.Our work followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Using CCDW data from 2010 to 2017, we identified people enrolled in fee-for-service Medicare who had a chronic condition flag that did not exist in the prior year. We limited our analysis to 51 conditions relevant to adults, and we limited the analysis to individuals who survived and remained in fee-for-service Medicare the entire year after they received a chronic condition flag. Using a serial cross-sectional design, we calculated condition persistence, defined as the proportion of enrollees who retained the chronic condition flag the year after they received the flag. We calculated year-to-year and sequential multiyear (up to 5 years) condition persistence. Analyses were conducted using SAS statistical software version 9.4 (SAS Institute) between March 3 and April 27, 2020. ResultsThis study included 70 871 475 Medicare fee-for-service beneficiaries (38 285 908 [54.0%] women); the mean (SD) age was 70.9 (12.2) years. Year-to-year condition persistence varied considerably across conditions. Among 188 252 beneficiaries with an acute myocardial infarction flag in 2011, 12 773 beneficiaries retained the flag in 2012 (6.8%). Of 187 664 beneficiaries with hip/pelvic fracture in 2011, 19 110 beneficiaries retained the flag in 2012 (10.2%). Persistence was higher for those with chronic kidney disease, with 1 098 973 of 1 183 808 beneficiaries who had the flag in 2011 retaining it in 2012 (92.8%), and for those with congestive heart failure, with 1 053 944 of 1 096 806 who had the flag in 2011 retaining it in 2012 (96.1%). Among 50 315 beneficiaries with personality disorder Author affiliations and article information are listed at the end of this article.Open Access. This is an open access article distributed under the terms of the CC-BY-NC-ND License.

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