Study of Myocardial Infarction Patients Examines Differences in Medicare Insurance Types

How do outcomes and treatment processes for traditional Medicare and Medicare Advantage compare?

 

As enrollment in private Medicare Advantage plans continues to increase among Medicare beneficiaries, research shows that patients enrolled in Medicare Advantage use fewer services than those enrolled in traditional Medicare.

A recent cohort study in JAMA conducted by Professors of Health Care Policy, Bruce Landon, MD, MBA, MSc, Alan Zaslavsky, PhD, along with HCP’s Christina Fu, Gabe Weinreb, and colleagues examines the outcomes and treatment processes for traditional Medicare vs Medicare Advantage.

Previously it has been unclear how these differences in care are influenced by factors such as unmeasured selection, care from different clinicians or hospitals, or care management tasks used by Medicare Advantage plans. However, studying the care patterns of patients who present with an acute condition that can be identified in a uniform way is one way to compare treatment.

Using acute myocardial infarction (MI) as a variable acute condition because of its agreed upon diagnostic criteria, and routine admission to the hospital, the retrospective cohort study observed participants with ST-segment elevation [acute] MI (STEMI) with non–ST-segment elevation [acute] MI (NSTEMI) presenting to US hospitals from 2009-2018. They compared 30-day mortality and treatment for Medicare Advantage and traditional Medicare patients presenting with acute (MI) from 2009 to 2018 and considered age- and sex-adjusted rates of procedure use, post discharge medication prescriptions and adherence, and measures of health system performance.

According to the study Medicare Advantage was significantly associated with modestly lower rates of 30-day mortality in 2009; these differences decreased and were no longer statistically significant by 2018. They also found that despite similar outcomes and use of cardiac procedures, MA patients were treated more efficiently with lower use of the ICU, higher rates of discharge to home, and lower rates of readmissions. MA patients also had higher rates of prescriptions for and adherence to recommended medications after a myocardial infarction. These findings may provide further insight into the difference in treatment and outcomes by Medicare insurance type.