Cardiovascular Risk Factor Management in Medicare Advantage and Traditional Medicare

Although cardiovascular disease is the leading cause of death in the United States among Medicare beneficiaries, management of modifiable risk factors remains suboptimal. Medicare Advantage (MA) enrollment has increased substantially; therefore, understanding the quality of cardiovascular risk factor management in MA is critical. In this study, we evaluated whether cardiovascular risk factor management was better among MA compared with traditional Medicare (TM) beneficiaries.

We linked physical examination and laboratory data from the National Health and Nutrition Examination Survey (2015-2018) to Medicare enrollment data. We calculated age- and sex-standardized differences for treatment and control rates of hypertension, diabetes, and hyperlipidemia among adults ≥65 years enrolled in MA compared with TM. National Health and Nutrition Examination Survey weights were used to calculate nationally representative estimates.

The weighted study population included 45 426 712 adults (34.4% MA, 65.6% TM). The mean age was 72.9 years and 55.3% were female. MA beneficiaries were more likely to be female (58.5% versus 53.5%), less likely to be White (71.7% versus 81.7%), and more likely to have household incomes <100% poverty (11.4% versus 7.0%). Treatment rates for hypertension (82.3% versus 79.1%; SD, 3.4 percentage points [pp]; [95% CI, -1.1 to 7.9]), hyperlipidemia (56.4% versus 56.0%; SD, 0.5 pp [95% CI, -5.7 to 6.8]), and diabetes (76.3% versus 82.5%; SD, -5.0 pp [95% CI, -13.1 to 3.1]) did not significantly differ between MA and TM beneficiaries. There were also no differences in control rates for hypertension (43.6% versus 46.1%; SD, -1.2 pp [95% CI, -8.8 to 6.4]), hyperlipidemia (51.5% versus 48.0%; SD, 4.0 pp [95% CI, -1.7 to 9.7]), and diabetes (61.5% versus 55.3%; SD, 4.4 pp [95% CI, -6.3 to 15.1]).

Despite the rapid rise in MA enrollment among individuals with cardiovascular risk factors and disease over the past decade, treatment and control rates for hypertension, diabetes, and hyperlipidemia were similar between MA and TM beneficiaries.