Ambulatory Care Access Better for Patients With Disabilities in Medicare Advantage vs Traditional Medicare

Beneficiaries with disabilities had better access to ambulatory care and higher quality of care while enrolled in Medicare Advantage (MA) as opposed to traditional Medicare (TM). Researchers published their findings in JAMA Health Forum.

“Medicare beneficiaries with disabilities aged 18 to 64 years comprise 15% of the Medicare population and experience considerable disparities in access to care compared with beneficiaries aged 65 years or older,” noted Kenton J Johnston, PhD, Department of Health Management and Policy, Saint Louis University, and coauthors. “Lack of access to high-quality ambulatory care is associated with negative clinical outcomes.”

The cohort study was conducted using data from the Medicare Current Beneficiary Survey from 2015 through 2018 and involved a “nationally representative, weighted sample of 7201 person-years.” Beneficiaries were on average 52.1 years of age. Data indicated that 65.1% of beneficiaries were White, 17.4% were Black, 10.2% were Hispanic, 4.2% were multiracial, 1.6% were Asian/Pacific Islander, and 1.4% were Native American.

Authors adjusted for confounding demographic, insurance, social, health, and area characteristics to compare enrollment, access, and quality. Access was evaluated using patient-reported measures such as usual source of care, primary care usual source of care, and specialist visits, while quality was determined by cholesterol screenings, influenza vaccinations, and colon cancer screenings.

Findings showed that 34.8% of people with disabilities enrolled in MA vs 41.2% of people who did not select disability entitlement. Researchers reported 2444 person-years in MA compared to 4757 person-years in TM out of the full sample.

Additionally, beneficiaries enrolled in MA vs TM were more likely to be of a minority race or ethnicity (35.7% vs 27.6%) and more likely to be enrolled in Part D (97.8% vs 80.3%).

MA was associated with better access and care quality compared to TM across 5 of the 6 patient-reported measures, including:

• usual source of care (90.2% vs 84.9%; adjusted propensity-weighted marginal difference [APWMD], 2.9%; 95% CI, .2%-5.7%);
• access to specialist visits (53.2% vs 44.8%; APWMD, 5.5%; 95% CI, .6%-10.5%);
• cholesterol screenings (91.1% vs 86.4%; APWMD, 3.8%; 95% CI, .9%-6.7%);
• influenza vaccinations (61.4% vs 51.5%; APWMD, 10.4%; 95% CI, 5.3%-15.5%); and
• colon cancer screenings (68.4% vs 54.6%; APWMD, 10.3%; 95% CI, 4.8%-15.8%).

Researchers also compared measures between those enrolled or not enrolled in special needs plans (SNPs). Beneficiaries with SNPs had better rates of influenza vaccinations (AD, 7.9%; 95% CI, .2%-15.6%) and colon cancer screenings (AD, 13.1%; 95% CI, 5.6%-20.5%) in MA vs TM. Beneficiaries not enrolled in SNPs saw better access and quality of care in MA vs TM across all 6 measures.

“These findings suggest that MA compares favorably with TM in meeting key preventive and ambulatory care needs of beneficiaries with disabilities,” authors concluded.

“The most surprising finding of this study was that the beneficial association of MA enrollment with access to care was concentrated among beneficiaries not enrolled in SNPs,” researchers wrote. “More research is needed to understand whether MA SNPs are meeting the needs of beneficiaries with disabilities.”

Reference:
Johnston KJ, Wen H, Pollack HA. Comparison of ambulatory care access and quality for beneficiaries with disabilities covered by Medicare Advantage vs traditional Medicare insurance. JAMA Health Forum. 2022;3(1):e214562. doi:10.1001/jamahealthforum.2021.4562