142nd APHA Annual Meeting and Exposition

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Diabetes disease management and Medicare Advantage market penetration: Findings from the Medical Expenditure Panel Survey

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Steven Howard, PhD, MBA , College for Public Health and Social Justice - Department of Health Management & Policy, Saint Louis University, St. Louis, MO
Matt Dietz, BS , College for Public Health and Social Justice - Department of Health Management & Policy, Saint Louis University, St. Louis, MO
Lindsey Pearson, BS , College for Public Health and Social Justice - Department of Health Management & Policy, Saint Louis University, St. Louis, MO
Samantha Ressler, MPH , College for Public Health and Social Justice - Department of Health Management & Policy, Saint Louis University, St. Louis, MO
Stephanie Bernell, PhD , Public Health, Oregon State University, Corvallis, OR
M. Faizan Casim, MPH , Healthcom Research & Solutions, Inc., Fredericksburg, VA
Jennifer Wilmott, MPH , Biostatistics, Saint Louis University, St. Louis, MO
Background: Diabetes mellitus affects more than 1 in 4 Americans over the age of 65, and accounts for 32 percent of total Medicare spending. This study advances our understanding of the relationships between Medicare Advantage (MA) market penetration and: (1) prevalence of diabetes or other diabetes-related cardiometabolic diagnoses, (2) prevalence of diabetes-related cardiometabolic diseases among diabetics, and (3) incidence of diabetes.

Methods: Data from the 2004-2008 Medical Expenditure Panel Survey (MEPS) Household Component were merged with MA market penetration data from CMS based on each beneficiary’s county of residence.  The explanatory variable of interest, county-level MA market penetration, was categorized in three levels: <12.5%, 12.5% to 24.9%, and ≥25% (Baker et al, 2004; Bundorf, 2004).  Diabetes-related comorbidities in MEPS included hypertension, coronary heart disease, stroke or transient ischemic attack, high cholesterol, diabetes-related eye or kidney disease, angina, and heart attack.

Results: Neither county-level MA market penetration nor the individual beneficiary’s type of insurance coverage had any statistically significant relationship with disease outcomes.  Rural residence was significantly associated with lower overall cardiometabolic disease prevalence.  However, rural Medicare beneficiaries with diabetes had more than 3 times greater odds of comorbidities than their urban counterparts.

Conclusions: Results do not support the hypothesis that MA market penetration is a significant factor regarding the disease outcomes studied.  This may be due to the inability to differentiate among MA plan types, or the relatively short periods between measurements in the MEPS panels. Future research should include in-depth analysis of this rural health disparity.

Learning Areas:

Administration, management, leadership
Advocacy for health and health education
Biostatistics, economics
Chronic disease management and prevention
Public health or related public policy
Public health or related research

Learning Objectives:
Explain how county-level Medicare Advantage market penetration affects the incidence and prevalence of diabetes and related diabetes co-morbid conditions.

Keyword(s): Medicare, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Steven Howard's work focuses on the research, development and evaluation of health reform initiatives and novel care delivery models. At the state level, this has included analysis of the development of the Coordinated Care Organization health reform model being implemented by the state of Oregon. His current federal-level research program involves study of the relationships between the market penetration of the Medicare Advantage program and changes in the chronic disease burden at a population level.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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