In a recent JAMA Network Open editorial, The Promise and Perils of Oncology Care in Medicare Advantage, Michael Ann Kyle and Nancy Keating comment on a manuscript that examined oncology care for Medicare beneficiaries enrolled in Traditional Medicare versus Medicare Advantage.

Traditional Medicare and Medicare Advantage both provide access to essential medical services, but they differ in their structure, benefits, and costs. Traditional Medicare offers a wider range of benefits; it also typically has higher out-of-pocket costs, while Medicare Advantage provides additional benefits like vision and dental coverage, lower out-of-pocket costs, but has narrower provider networks. 

The authors summarized original research published in JAMA Network Open that found that Medicare Advantage enrollees generally used fewer resources, primarily due to savings on physician-administered chemotherapy. This was attributed to the use of less expensive chemotherapy regimens and fewer chemotherapy administration visits.

Drs. Kyle and Keating highlighted strategies used by Medicare Advantage to control resource use, including utilization management tools like prior authorization.  Prior authorization processes impose administrative burdens that may limit access to potentially important medications and delayed or discontinued care among patients already taking cancer drugs as well as the administrative burden experienced by physicians and patients in getting medications approved. They also highlight Medicare Advantage plans’ use of defined provider networks, which may steer patients to physicians and practices with less resource-intensive practice styles but may limit patients’ choices about who they see for care.

Despite some limitations of the original research study, Drs. Kyle and Keating felt that it provided evidence about the potential for Medicare Advantage to prompt potentially higher-value care for patients receiving chemotherapy. Nevertheless, they believe that additional research is necessary to ensure that such lower research use did not come at the expense of high quality, guideline-recommended care for these beneficiaries.