Those enrolled in Medicare Advantage plans are less likely to be prescribed high-risk medications than those enrolled in traditional fee-for-service Medicare plans, a new study found.
The study, published last week in JAMA Network Open, analyzed about 5.6 million Medicare Advantage beneficiaries and about 6.6 million traditional Medicare beneficiaries from 2013 and 2018. High-risk medications “are defined as medications that should be avoided for older patients because of age-related changes in pharmacodynamics and chronic illness burden that may increase these patients’ risk of avoidable hospitalization, health care spending, and death,” according to the report.
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“Despite consensus that [high-risk medications] should be minimized, they are commonly prescribed to older adults,” the researchers stated. “As people live longer and multimorbidity continues to rise, the risk of potentially harmful drug-disease interactions and adverse events will also likely increase. Therefore, identification of strategies that reduce the use of [high-risk medications] in this population is critically important.”
The researchers found that on average in 2013, Medicare Advantage enrollees filled 135.1 unique high-risk medications per 1,000 beneficiaries, versus 165.6 unique high-risk medications per 1,000 beneficiaries for traditional Medicare. In 2018, there were 41.5 high-risk medications per 1,000 beneficiaries for Medicare Advantage, compared to 56.9 high-risk medications per 1,000 beneficiaries for traditional Medicare.
Throughout the study period, Medicare Advantage enrollees received 24.3 fewer high-risk medications per 1,000 beneficiaries per year than traditional Medicare enrollees.
There are several reasons for why Medicare Advantage beneficiaries are less likely to receive high-risk medications, the researchers explained.
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“Prior work has documented that Medicare Advantage plans engage in aggressive utilization management strategies,” the study said. “It is possible that because Medicare Advantage plans are responsible for not only Part D care but also Parts A and B, their prescribing practices are more effective than those of traditional Medicare, minimizing subsequent cost of care. Additionally, Medicare Advantage’s capitation-based payment system incentivizes clinicians to avoid costly care. Medicare Advantage quality is directly incentivized through the Star Rating System and its associated bonus program to optimize performance on HEDIS quality-of-care measures given that they are rewarded for higher star ratings.”
The study also found that female, American Indian or Alaska Native and White populations were more likely to be prescribed high-risk medications over other populations.
“Given that [high-risk medication] use was associated with worse clinical outcomes, these findings showed a potentially lower quality of care among clinicians who disproportionately served American Indian or Alaska Native beneficiaries, due in part to past and continued severe underfunding of health infrastructures for this population,” the study said. “As for higher rates among White populations vs other minority groups, some of these differences may be associated with underlying race-differential prescription bias from clinicians. For example, prior work has documented that clinicians were less likely to treat pain among Black than White populations for different medical and surgical conditions.”
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