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

Paul Fishman,Sungchul Park,Eric B. Larson,Lindsay White,Norma B. Coe

doi:10.1001/jamanetworkopen.2020.1809

Abstract

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. To determine differences in health care utilization, care satisfaction, and health status for MA and TM beneficiaries with and without ADRD. 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. Enrollment in MA. Self-reported health care utilization, care satisfaction, and health status. 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. 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.

Highlights

Caring for people with Alzheimer disease and related dementias (ADRD) will generate substantial costs to the US health care system
A similar trend was observed among beneficiaries without ADRD, but the difference was greater between Medicare Advantage (MA) and traditional fee-for-service Medicare (TM) beneficiaries with ADRD than between MA and TM beneficiaries without ADRD
No or negligible differences were detected in care satisfaction and health status between MA and TM beneficiaries with and without ADRD

Summary

Introduction

Caring for people with Alzheimer disease and related dementias (ADRD) will generate substantial costs to the US health care system. Both the number of individuals with ADRD and the associated costs are projected to increase over time. As of 2010, there were 4.5 million US individuals with ADRD, and that number is expected to increase to 13.2 million in 2050.1 In addition, mean per-person Medicare costs for beneficiaries with ADRD were estimated to be $23 497 in 2011, more than triple the mean $7223 costs for Medicare beneficiaries without ADRD.[2,3] Total costs (including health care, long-term care, and hospice services) for Medicare beneficiaries with ADRD are projected to increase from $172 billion in 2010 to $1.1 trillion in 2050.3 Such a dramatic increase in the costs associated with ADRD will pose a substantial burden to the US federal government. The MA plans use various techniques to control health care utilization, such as restricted practitioner networks, prior authorization, and utilization review, as well as investing in preventive services, care coordination, and chronic disease management.[5,6,7,8,9]

Methods

Results

Discussion

Conclusion