Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias

Abstract

IMPORTANCE Compared with traditional Medicare (TM) fee-for-service plans, Medicare Advantage (MA) plans may provide more-efficient care for beneficiaries with Alzheimer disease and related dementias (ADRD) without compromising care quality. OBJECTIVE To determine differences in health care utilization, care satisfaction, and health status for MA and TM beneficiaries with and without ADRD. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019. EXPOSURES Enrollment in MA. MAIN OUTCOMES AND MEASURES Self-reported health care utilization, care satisfaction, and health status. RESULTS The sample included 47 100 Medicare beneficiaries (25 900 women [54.9%]; mean [SD] age, 72.2 [11.4] years). Compared with TM beneficiaries with ADRD, MA beneficiaries with ADRD had lower utilization across the board, including a mean of −22.3 medical practitioner visits (95% CI, −24.9 to −19.8 medical practitioner visits), −2.3 outpatient hospital visits (95% CI, −3.6 to −1.1 outpatient hospital visits), −0.2 inpatient hospital admissions (95% CI, −0.3 to −0.1 inpatient hospital admissions), and −0.1 long-term care facility stays (95% CI, −0.2 to −0.1 long-term care facility stays). A similar trend was observed among beneficiaries without ADRD, but the difference was greater between MA and TM beneficiaries with ADRD than between MA and TM beneficiaries without ADRD (mean, −15.0 medical practitioner visits [95% CI, −18.7 to −11.3 medical practitioner visits], −1.7 outpatient hospital visits [95% CI, −3.0 to −0.3 outpatient hospital visits], and −0.1 inpatient hospital admissions [95% CI, −1.0 to 0.0 inpatient hospital admissions]). Overall, no or negligible differences were detected in care satisfaction and health status between MA and TM beneficiaries with and without ADRD. CONCLUSIONS AND RELEVANCE Compared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.

Trends in Use of Low-Value Care in Traditional Fee-for-Service Medicare and Medicare Advantage

“… 12 , 13 Indeed, MA tends to deliver care more efficiently than TM by increasing use of primary care visits 14 , 15 and decreasing use of unnecessary care or intensity of care. 16 , 17 , 18 , 19 , 20 However, to our knowledge, evidence on use of low-value care in MA is limited. A 2017 study 5 examined use of low-value care in MA but was limited to using data from a single insurer.…”

Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer’s disease and related dementias

“…We included Medicare beneficiaries (aged 65 and above) who were non-Latino white, non-Latino Black, non-Latino Asian, or Latino. Then, we identified the following three populations: [ 1 ] those who reported as not having cognitive deficits, [ 2 ] those who reported as having cognitive deficits without a diagnosis of ADRD, and [ 3 ] those diagnosed with ADRD. MEPS measured cognitive deficits based on the household respondent’s answers for the individuals in the sample.…”

“…Our outcomes included eight health care expenditures: [ 1 ] total health care expenditures, [ 2 ] OOP expenditures, and [ 3 ] six service-specific expenditures. Service-specific expenditures included inpatient expenditures, outpatient expenditures, office-based expenditures, emergency room (ER) expenditures, home health expenditures, and prescription drug expenditures.…”

“…The number of Americans with ADRD is projected to be 13.8 million in 2050 [ 1 ]. Furthermore, evidence suggests that care for ADRD generates substantial health care costs [ 2 – 5 ]. Mean per-person costs for Americans with ADRD were $49,126 in 2016, more than triple the average $15,550 per-person costs for Americans without ADRD [ 5 ].…”

Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer's disease and related dementias

“…The number of Americans with ADRD is projected to be 13.8 million in 2050 (1). Furthermore, evidence suggests that care for ADRD generates substantial health care costs (2)(3)(4)(5). Mean per-person costs for Americans with ADRD were $49,126 in 2016, more than triple the average $15,550 per-person costs for Americans without ADRD (5).…”