Lessons From Medicare Advantage on Effective Treatment of Diabetes

Dr. Gary Puckrein, President & CEO, National Minority Quality Forum

 Dr. Gary Puckrein

The scourge of diabetes is well known to all of us in the health care community, especially among those of us who work with minority populations. Approximately, one-quarter of the Medicare population has Type 2 diabetes, and the numbers are only increasing. The current fee-for-service system is not conducive to effective diabetes care. Patients are predominantly treated in primary care practice settings where providers have limited time and are often ill-equipped to deal with the complex medical and psychosocial needs of diabetic patients.

It is important that Medicare look at new ways to treat this disease that is not only devastating for patients and their families, but also expensive to taxpayers. To that end, the Secretary of Health and Human Services recently announced an initiative to encourage higher quality, lower cost care to Medicare patients. She set a goal of tying 85 percent of all fee-for-service Medicare payments to quality or value by 2016. This will particularly impact patients with chronic disease like diabetes because providers will now have an incentive to achieve higher quality rather than just provide more services.

As we focus on moving fee-for-service Medicare into a new era of chronic disease treatment, there are great lessons to be learned from Medicare Advantage. As an issue brief released last week by the Better Medicare Alliance highlights, Medicare Advantage’s diabetes prevention, treatment and management services are achieving results. Provided in the context of care coordination and screening services, including vision care, evidence-based treatment and services during transitions from one care setting to another, Medicare Advantage has the flexibility and incentive to innovate around chronic disease precisely because they are at-risk, and it is working.

As the issue brief illustrates, Medicare Advantage patients enrolled Chronic Care/Special Needs Plans experienced improved quality of care and better outcomes because of the unique benefits of Medicare Advantage. In fact, in one 5-state case study, Medicare Advantage enrollees had 9% lower hospital admission rates, 19% fewer hospital days and 28% fewer hospital readmissions. Further, HEDIS measures indicate that Medicare Advantage outperforms fee-for-service Medicare on a number of diabetes measures, including eye exams, glycated hemoglobin testing, LDL cholesterol testing and nephropathy screening.

In our discussions about Medicare Advantage, we have largely overlooked the benefits of their structure for innovation in chronic disease. As this Issue Brief highlights, we should be taking a closer look and learning from the Medicare Advantage experience. Our diabetic Medicare patients deserve the highest quality health care.