Connect

A first-of-its-kind analysis has revealed significant differences in stroke outcomes and stroke care for patients on government-run, traditional Medicare plans — versus those on Medicare Advantage offered by private insurers.

UVA Health researchers found that patients on traditional — or “fee-for-service” — Medicare Part A, B, and D plans operated by the government were less likely to have access to certain stroke-preventing care. However, they were more likely to receive intensive post-stroke care and rehabilitation than those enrolled in Medicare Advantage, where private insurance plans are incentivized to limit more expensive medical care. 

Both groups’ overall recovery outcomes appeared similar, but improvements happened more quickly for stroke patients with Medicare Advantage insurance. Participants in the private plan were less likely to be readmitted to a hospital, and they were more likely to move into assisted-living and other community-living accommodations.

The researchers caution that the data they had available was limited and that it could be difficult to make direct comparisons between the plans. But they say their analysis can inform discussions about healthcare costs and America’s aging population.

“Stroke is one of the leading causes of death and disability in the United States. Most stroke patients have Medicare insurance, but we do not know how changes in Medicare impact stroke patients. Our research suggests that changes in Medicare insurance, including the growth of private insurance through Medicare Advantage, could be important for stroke patients,” says researcher Jonathan R. Crowe, MD, MPH, MSc, neurologist and stroke expert at UVA Health and UVA School of Medicine.

He adds: “In our country, people are worried about healthcare costs and how health insurance impacts patients. Those concerns are real, and they are not going away. Our population in the United States is getting older, and more Americans will be enrolling in Medicare as they retire. Our country needs research that helps patients, doctors and policymakers understand how different parts of Medicare impact patients. This will be really important for the future of U.S. healthcare.”

Medicare Options

Strokes are a leading cause of death and long-term disability in the United States. They are most likely to strike people ages 65 and older, and most people in that demographic are on Medicare. Among Medicare enrollees, more than half are on Medicare Advantage, a Medicare alternative that was designed to reduce healthcare costs by encouraging competition among private insurers. 

However, federal government payments for Medicare Advantage have substantially exceeded the costs that would have been needed for traditional Medicare, which is run directly by the government. The Medicare Payment Advisory Commission, for example, estimates that government payments to Medicare Advantage in 2025 cost about 20% more, or an additional $84 billion, health policy nonprofit KFF reports.

Medicare and Medicare Advantage are built on two very different payment approaches. Under traditional Medicare, the government pays healthcare providers for services rendered, with no annual cap, potentially encouraging use and overuse. For Medicare Advantage, on the other hand, the government provides private insurers fixed payments to cover beneficiaries. This creates incentives for insurers to find ways to reduce costs, such as limiting networks, implementing annual payment caps and requiring authorizations prior to care. 

About the Analysis

The nation’s rising healthcare costs and the growing needs of its aging population have sparked vigorous debate about the best way forward. That spurred Dr. Crowe and his colleagues to conduct their review of stroke care. 

After surveying the available scientific literature, the researchers found seven studies that allowed them to compare patient outcomes. In addition to survival and atrial fibrillation (irregular heartbeat), the researchers looked at patients’ access to preventive care such as smoking cessation programs; at post-stroke care such as rehabilitation and rehospitalization; and at general wellness factors such as blood-sugar levels and blood pressure.

The researchers found that post-stroke care was generally less common among Medicare Advantage enrollees. This, the experts say, likely reflects prior authorization requirements to limit use.

Medicare and Advantage patients ultimately showed similar outcomes, the researchers found, though it took longer for traditional Medicare enrollees to reach the same level of improvement as Advantage enrollees. One potential explanation for this could be that Advantage patients were in better overall health before their strokes, the researchers suspect. Medicare Advantage enrollees appeared to have easier access to programs to help them stop smoking, manage their cholesterol and take other steps that can reduce stroke risk.

The researchers are urging further study to inform the nation’s future healthcare policies. They say obtaining additional clinical data, including from a stroke registry linked to Medicare data, would help clarify the differences in care received.

“All of us need to work together to make our healthcare system better,” Dr. Crowe says. “We hope that this study can be part of our country’s conversation about how to fix healthcare.”

Findings Published

The researchers have published their analysis in the Journal of Comparative Effectiveness. The article is free to read. The review team consisted of Emily J. Bian, Priyanka Menon, Kathleen A. McManus, Timothy J. Layton, Bradford B. Worrall and Crowe.

The researchers have no financial interest in the work.

To keep up with the latest medical research news from UVA Health and UVA’s Paul and Diane Manning Institute of Biotechnology, subscribe to the Making of Medicine blog.