Although Medicare Advantage (MA) beneficiaries with coronary artery disease (CAD) are more likely to receive secondary prevention therapies than traditional fee-for-service (FFS) Medicare beneficiaries with CAD, this may not translate into better patient outcomes, according to the results of an observational and retrospective analysis published in JAMA Cardiology.
De-identified data of patients who were diagnosed with CAD between January 1, 2013 and May 1, 2014 at centers that participated in the Practice Innovation and Clinical Excellence (PINNACLE) registry were included in the analysis. Specifically, the study researchers compared patients with CAD who were enrolled in MA (n=35,563) and FFS Medicare (n=172,732). The definition of CAD included patients with a clinical history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting. Patterns in medication prescriptions in eligible patients and intermediate outcomes (eg, changes in blood pressure and low-density lipoprotein cholesterol) represented the primary outcomes.
Beneficiaries of MA were significantly more likely to receive secondary prevention treatments compared with their FFS Medicare beneficiary counterparts. In comparison with FFS Medicare beneficiaries, MA beneficiaries were more likely to receive β-blockers (80.6% vs 78.8%, respectively; P <.001), angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (70.7% vs 65.1%, respectively; P <.001), and statins (68.4% vs 64.5%, respectively; P <.001). MA enrollees also had a significantly greater likelihood of receiving all 3 medications when deemed eligible (48.9% vs 40.4%; P <.001).
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In the adjusted analysis, MA beneficiaries had greater odds of receiving guideline-recommended therapy vs FFS Medicare beneficiaries for β-blockers (odds ratio [OR] 1.10; 95% CI, 1.04-1.17; P =.002), angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (OR 1.13; 95% CI, 1.08-1.19; P <.001), as well as all 3 medications (OR 1.23; 95% CI, 1.001-1.50; P =.047).
No differences were observed between MA and FFS Medicare enrollees in terms of changes in systolic and diastolic blood pressure and low-density lipoprotein cholesterol levels.
The voluntary nature of the PINNACLE registry, the observational nature of the analysis, and the lack of data regarding the duration of patients’ CAD therapy were potential study limitations.
“As MA continues to enroll a higher proportion of beneficiaries each year,” the researchers concluded, “it will be important to monitor both quality and outcomes of care to determine whether these patterns ultimately lead to better outcomes in Medicare.”
Reference
Figueroa JF, Blumenthal DM, Feyman Y, et al. Differences in management of coronary artery disease in patients with Medicare Advantage vs traditional fee-for-service Medicare among cardiology practices [published online February 20, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.0007
