Characteristics Of Medicare Beneficiaries Research Articles

Substance Use Disorders Among Medicare Beneficiaries: Prevalence, Mental and Physical Comorbidities, and Treatment Barriers

This study aimed to determine the prevalence of treated and untreated substance use disorders among Medicare beneficiaries, the characteristics of Medicare beneficiaries with substance use disorders, and reasons for their unmet needs. This study used data from the National Survey of Drug Use and Health, 2015-2019. Substance use disorder was defined based on DSM-IV dependence or abuse criteria. Descriptive analyses were conducted in 2021, including testing for differences in unadjusted means. Approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorder (8% of Medicare beneficiaries aged <65 years and 2% aged ≥65 years). Overall, 77% had an alcohol use condition, 16% had a prescription drug use condition, and 10% had a marijuana use condition. Of those who had past-year substance use disorder, 11% received treatment for their condition. Common reasons for not receiving treatment were lack of motivation (41%), financial barriers (33%), concern about what others might think (24%), logistical barriers such as lack of transportation (21%), and uncertainty about treatment efficacy (13%). Medicare beneficiaries with substance use disorders were more than twice as likely to have past-year serious psychological distress as those without substance use disorders (44% vs 21%, p<0.001 for those aged <65 years; 14% vs 4%, p<0.001 for those aged ≥65 years). Percentages of past-year suicidal ideation were also much higher among Medicare beneficiaries with substance use disorders than without (24% vs 6%, p<0.001 for those aged <65 years; 7% vs 2%, p=0.006 for those aged ≥65 years). Few Medicare beneficiaries who need substance use disorder treatment receive it. Reducing Medicare coverage gaps and stigma may help meet this need.

MEDICAID FINANCING IN ASSISTED LIVING AND CHARACTERISTICS OF MEDICARE DUAL-ELIGIBLE RESIDENTS

An increasing number of assisted living (AL) residents rely on Medicaid waivers or state plans to pay for personal care and other supportive services. States may finance services for duals residing in AL through Medicaid waivers and state plans, but the availability of coverage varies – some states offer little to no Medicaid coverage for services in AL, and others offer multiple pathways to receiving assistance. Little is known about duals in AL, including how many have access to AL and the quality of care they receive there. The present study compares the characteristics of Medicare beneficiaries residing in large AL settings, by dual-eligibility status, and investigates the variability in the share of duals in AL among states. We identified 586,397 Medicare beneficiaries residing in AL in 2014. Medicare claims were used to measure health characteristics and health care utilization. Duals represented 16% of AL residents in our cohort. Compared to non-duals, duals were more often older adults of color (24 vs 4%), and more likely to qualify for Medicare due to disability (46 vs 7%). Duals had higher rates of hospitalizations (24 vs 21%) and skilled nursing facility use while in AL (11 vs 10%), and more chronic conditions than non-duals. States varied in the share of AL residents who are duals, ranging from 6% in New Hampshire to 41% in New York. State policies that may contribute to variation in the prevalence of duals in AL and implications of these findings for policy-makers and residents will be discussed.

HOSPICE SERVICES IN THE HOME SETTING AND CHARACTERISTICS OF MEDICARE DECEDENTS

There is little empirical work documenting the characteristics of Medicare beneficiaries receiving hospice services in the home setting using the Medicare place of service codes. The objective of this study is to examine differences in Medicare decedents who received hospice services in traditional and non-traditional homes (assisted living, and nursing home settings) defined by these codes. We conducted a secondary analysis of 675,782 Medicare decedents who received hospice services in 2015. Chi-squared and ANOVA tests were used to describe the socio-demographics, health conditions, utilization, and hospice payments of the decedents. Most of the decedents received hospice care in a traditional home (64.9%), but beneficiaries, aged 85 years and over, received hospice services in assisted living (72.1%) or nursing homes (59.8%). Overall, decedents who received Medicare hospice benefits in assisted living had the highest number of hospice days (mean=149.7 lifetime days; median = 30; standard deviation (S.D.) =245), and decedents in traditional homes had the fewest number of hospice days (mean=86.7 lifetime days; median = 24; S.D. =179). Among Medicare–Medicaid (duals) decedents who used hospice care, 49% received hospice care in nursing homes, and infrequently, 7% at assisted living. Medicare hospice payments were highest ($20,439 per beneficiary) for decedents in assisted living, but least for those in traditional homes ($11,830). Hospice services offered to Medicare beneficiaries who are 85 years and older, duals, or have a diagnosis of dementia may require more oversight and coordination of resources to ensure that they receive appropriate hospice services in non-traditional homes.

Characteristics of Medicare Beneficiaries With Intellectual or Developmental Disabilities.

Gaps in knowledge and systematic tracking of the prevalence of intellectual and developmental disabilities (IDD) and characteristics that may affect the health of this disability group limits our ability to address the health disparities they experience in comparison to people without disability. The purpose of this study is to begin to fill one relevant critical gap in knowledge: understanding the demographics and health outcomes of adults with IDD who receive services under Medicare Fee-for-Service (FFS), many of who are also eligible for Medicaid. Using 2016 Medicare administrative claims, we examined the prevalence and characteristics of five diagnosis groups of IDD, in those under 65 and those 65 and over, as well as their health outcomes. We found that the IDD Medicare FFS group had high prevalence rates for chronic physical and mental health conditions, overuse of emergency departments, and high rate of 30-day readmission. These findings highlight the need for evidence-based health care coordination, improved and increased public health interventions, and continued surveillance.

Medicare Beneficiaries With a Specialist as Their Personal Doctor Report Better Experiences With Care.

Health plans often require that patients have a personal doctor. Older adults rely on specialists for much of their care and may use a specialist in this role, but little is known about how many or which Medicare beneficiaries use specialists as their personal doctor and how their care experiences differ from others'. To examine the prevalence and characteristics of Medicare beneficiaries with a specialist as a personal doctor and compare their patient experiences and immunization to other beneficiaries'. Logistic regression predicted having a specialist as a personal doctor from beneficiary characteristics. Doubly-robust models compared 7 patient experience and 2 immunization measures for beneficiaries with and without a specialist as their personal doctor. Interactions of a specialist indicator and beneficiary characteristics tested for moderators. A total of 227,642 Medicare beneficiaries aged 65+ who reported having a personal doctor on the 2014 Medicare CAHPS survey. In total, 20% of beneficiaries reported that their personal doctor was a specialist, fewer than previously reported for the most frequently visited physician (43%); beneficiaries who were older, less healthy, less educated, racial/ethnic minorities, had fee-for-service coverage, or had lower income were more likely to do so. They also reported better patient experiences than those with nonspecialist personal physicians on 6 of 7 measures and more immunizations; the largest difference was for care coordination. Having a specialist personal doctor was associated with particularly positive patient experience for low income, Black, Hispanic, and less healthy beneficiaries. Future research should investigate whether specialists as personal doctors may reduce patient-experience disparities for vulnerable patients.

Abstract P206: Differences in the Characteristics of Medicare Beneficiaries with Heart Failure According to Enrollment in the Medicare Part D Prescription Drug Benefit

Background The need for comparative effectiveness studies is a national priority because efficacy studies for drug approval enroll highly selected patients. In particular, comparative effectiveness of drug therapies in heart failure (HF) is needed because HF represents a substantial portion of annual Medicare spending. Drug exposures are now captured for Medicare beneficiaries enrolled in prescription drug plans (Part D), but the population of Part D enrollees with HF has not been described. Methods Using a 5% national sample of Medicare claims data, we created 2 annual cohorts of Medicare beneficiaries having prevalent HF as of January 1, 2006 and January 1, 2007. We included beneficiaries aged 65 years or older who had at least 12 months of prior fee-for-service enrollment and had HF reported on one inpatient claim or at least 3 outpatient claims during the prior year. We classified patients according to enrollment in a Part D plan as of January 1st of the cohort year. We compared demographics and comorbidities of patients enrolled to those not enrolled in a Part D plan. Results We identified 91,135 eligible beneficiaries with prevalent HF as of January 1, 2006 and 87,344 as of January 1, 2007. Among the 2006 cohort, 35,883 (39%) had enrolled in a Part D plan as of January 1, 2006. Enrollment increased to 50,834 (58%) in the 2007 cohort. Part D enrollees tended to have fewer comorbidities and were more likely to be female and black (Table). Additionally, Part D enrollees were more likely to have a portion of their Medicare Part A and B premiums paid for by the state (state buy-in), an indication of low-income status. Conclusions Medicare beneficiaries with HF differ significantly according to enrollment in Part D prescription drug plans and represent a population underrepresented in clinical efficacy trials. Studies with Part D claims data linked to a clinical registry may inform clinical practice as to the effectiveness of drug therapy in real-world settings. Baseline characteristics of Medicare beneficiaries with HF according to enrollment in Part D * Variable 2006 2007 Not Part D Enrolled Part D Enrolled Not Part D Enrolled Part D Enrolled N 55,252 35,883 36,510 50,834 Demographics Age, mean (SD),y 80.1 (7.6) 80.7 (8.2) 80.1 (7.4) 80.7 (8.1) Gender, male 26,447 (47.9%) 11,083 (30.9%) 19,087 (52.3%) 17,242 (33.9%) Race, non-white 6,434 (11.7%) 7,622 (21.2%) 4,011 (11.0%) 9,465 (18.6%) State buy-in 1,713 (3.1%) 19,419 (54.1%) 208 (0.6%) 19,808 (39.0%) Comorbidities Coronary heart disease 40,606 (73.5%) 25,026 (69.7%) 27,172 (74.4%) 35,960 (70.7%) Diabetes mellitus 24,093 (43.6%) 18,197 (50.7%) 16,381 (44.9%) 25,156 (49.5%) Cerebrovascular disease 17,350 (31.4%) 12,714 (35.4%) 11,745 (32.2%) 17,734 (34.9%) Myocardial infarction 12,988 (23.5%) 7,436 (20.7%) 8,565 (23.5%) 10,787 (21.2%) Peripheral vascular disease 20,079 (36.3%) 14,779 (41.2%) 13,708 (37.5%) 20,861 (41.0%) * p values for all comparisons are &lt;.001

Health Plan Choice in the Twin Cities Medicare Market

This paper examines the relationship between characteristics of Medicare beneficiaries and their choice of health plan in the Twin Cities during 1988. This analysis provides the first comparison of beneficiaries in the basic fee-for-service (FFS) Medicare sector (without a supplementary policy) to beneficiaries in the FFS sector with a supplementary policy, enrollees in independent practice associations (IPAs), and network health maintenance organizations (HMOs). The site and time period are important because there were five large, mature HMOs with TEFRA-risk contracts operating at that time, enrolling 50% of Medicare beneficiaries in the market area. We find that the oldest, poorest and, to a lesser extent, the sickest Medicare beneficiaries were most likely to have basic FFS Medicare coverage without supplementary insurance. The youngest enrollees are found in network HMOs. The availability of group coverage and premium subsidies are positively associated with choice of FFS with a supplementary policy. Government policy concerning Medicare HMO premiums appears to contribute to the poorest beneficiaries facing the highest out-of-pocket costs.