Differences in Management of Coronary Artery Disease in Patients with Medicare Advantage vs Traditional Fee-for-Service Medicare among Cardiology Practices

Abstract

Importance: One-third of Medicare beneficiaries are enrolled in Medicare Advantage (MA), Medicare's private plan option. Medicare Advantage incentivizes performance on evidence-based care, but limited information exists using reliable clinical data to determine whether this translates into better quality for patients with coronary artery disease (CAD) enrolled in MA compared with those enrolled in traditional fee-for-service (FFS) Medicare. Objective: To determine differences in evidence-based secondary prevention treatments and intermediate outcomes among patients with CAD enrolled in MA vs FFS Medicare. Design, Setting, and Participants: In this observational, retrospective, cohort study, deidentified data from patients 18 years or older diagnosed as having CAD between January 1, 2013, and May 1, 2014, at cardiology practices participating in the Practice Innovation and Clinical Excellence (PINNACLE) registry were studied, including 35563 patients enrolled in MA and 172732 enrolled in FFS Medicare. Data were analyzed from March to July 2018. Exposures: Medicare Advantage enrollment. Main Outcomes and Measures: Medication prescription patterns among eligible patients and intermediate outcomes, including blood pressure and low-density lipoprotein cholesterol. Results: Of the 35563 patients with CAD enrolled in MA, 20193 (56.8%) were male, and the mean (SD) age was 76.7 (7.6) years; of the 172732 patients with CAD enrolled in FFS Medicare, 100025 (57.9%) were male, and the mean (SD) age was 77.5 (8.0) years. Patients enrolled in MA were younger, less likely to be white, and more likely to be female and to have heart failure, diabetes, and chronic kidney disease compared with those enrolled in FFS Medicare. Compared with FFS Medicare beneficiaries, MA beneficiaries were more likely to receive secondary prevention treatments, including β-blockers (80.6% vs 78.8%; P