Not only is healthcare siloed and fragmented, but it can also be the same within an organization. Budgets are tight, resources are limited, and everyone is doing their best to achieve big goals. Many plans with Medicare Advantage (MA) lives, even those with successful care management programs in place, are up against trends that will only make the job of delivering quality-focused chronic care management programs even harder over the next 5-10 years.
Here are the trends to track (and share) related to chronic care among Medicare-aged populations:
Population trends
1. Expect millions of new Medicare beneficiaries over the next four decades—Americans over age 65 will nearly double to almost 95M seniors by 2060. (1)
2. More seniors will join MA plans by 2032, with a 61% share of Medicare beneficiaries enrolled in MA plans. (2)
3. Nearly three-quarters of the MA population (73%) has at least one chronic condition. (3)
Cardiovascular disease
4. Nearly 70% of Medicare beneficiaries are diagnosed with hypertension. (4)
5. Total CVD costs will double (for those aged 65-79) or triple (age 80+) across all heart conditions by 2035. (5)
Chronic kidney disease
6. $1 of every $5 spent in Medicare is for beneficiaries with CKD and kidney failure—costing $125B in 2019. (6)
7. The majority of people living with CKD (90%!) don’t even know they have it. (6)
Diabetes
8. More than 37% of MA beneficiaries have diabetes, compared to 10.5% of the U.S. population. (1)
9. Of total diabetes costs, 61% are attributed to adults aged 65 or older. (7)
Obesity
10. Per capita healthcare spend attributable to severe obesity for people 65 and older is >$3K annually. (8)
11. Projections are that the number of people aged 65+ with extreme obesity (BMI > 40 kg/m2) will more than double by 2030. (9)
Respiratory
12. Compared to the U.S. population at 6.4%, MA beneficiaries have a prevalence of COPD (20%). (1)
13. With an increase in total number of patients diagnosed with COPD, expect higher COPD-related costs—inpatient care will rise 182% and hospitalization by 210%. (10)
Comorbidities
14. For seniors with chronic conditions (compared to those with none), those with one chronic condition are 55% more likely to choose MA plans and those with five or more chronic conditions are 70% more likely to choose MA plans. (11)
15. For a person with diabetes, 48% to 64% of lifetime medical costs are diabetes-related, including heart disease and stroke. (12)
16. One in five Medicare beneficiaries also have depression. (4)
Healthcare Disparities
17. More than one-third of MA beneficiaries identify as a racial or ethnic minority. (1)
18. More than half of MA beneficiaries (52.7%) live below 200% of the federal poverty level. (1)
19. Among Medicare beneficiaries, 40% reported having at least one unmet social need. (13)
20. One in three rural adults is enrolled in Medicare. (14)
Understanding these trends can help you design a program that delivers a better, more engaging member experience. But what impact will these trends have on your plan’s performance and what can you do about it?
Sources
(Accessed: 24 January 2023)
- Better Medicare Alliance (2022) State of Medicare Advantage. Available at: https://bettermedicarealliance.org/wp-content/uploads/2022/07/BMA-State-of-MA-2022-FIN.pdf
- Freed M et al. (2022) Medicare Advantage in 2022: Enrollment Update and Key Trends. Available at: https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/
- Carlton S, Jamieson D, Machado-Pereira M. (2020) Supplemental benefit changes in Medicare Advantage increase options for those with chronic conditions. Available at: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/supplemental-benefit-changes-in-medicare-advantage-increase-options-for-those-with-chronic-conditions
- CMS. Medicare Tables & Reports. Available at: https://www2.ccwdata.org/web/guest/medicare-tables-reports
- American Heart Association (2017) Cardiovascular Disease: A Costly Burden for America. Available at: https://www.heart.org/-/media/Files/About-Us/Policy-Research/Fact-Sheets/Public-Health-Advocacy-and-Research/CVD-A-Costly-Burden-for-America-Projections-Through-2035.pdf
- Azar A. (2023) Industry Voices—Pushing toward a new standard in kidney care. Available at: https://www.fiercehealthcare.com/providers/industry-voices-pushing-toward-new-standard-kidney-care
- American Diabetes Association. (2018) Economic Costs of Diabetes in The U.S. in 2017. Available at: https://diabetesjournals.org/care/article/41/5/917/36518/Economic-Costs-of-Diabetes-in-the-U-S-in-2017
- Wang WC et al. (2015) Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion in 2013. Available at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0633
- Gaudette É, Goldman D. (2015) Medicare’s big fat problem, fiscal and otherwise. Available at: https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2015/06/04/medicares-big-fat-problem-fiscal-and-otherwise/
- Khakban A et al. (2016) The Projected Epidemic of Chronic Obstructive Pulmonary Disease Hospitalizations over the Next 15 Years. Available at: https://www.atsjournals.org/doi/pdf/10.1164/rccm.201606-1162PP
- Thorpe K. (2018) Beneficiaries with Chronic Conditions More Likely to Actively Choose Medicare Advantage. Available at: https://bettermedicarealliance.org/wp-content/uploads/2020/03/BMA_ThorpeReport_2018_09_13.pdf
- Zhou X et al. (2013) Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. Available at: https://pubmed.ncbi.nlm.nih.gov/23953350/
- Hutchins Coe E et al. (2020) Understanding the impact of unmet social needs on consumer health and healthcare. Available at: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/understanding-the-impact-of-unmet-social-needs-on-consumer-health-and-healthcare
- Turrini G et al. (2021) Access to Affordable Care in Rural America: Current Trends and Key Challenges. Available at: https://aspe.hhs.gov/sites/default/files/2021-07/rural-health-rr.pdf