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Role of PCPs in diagnosing dementia in traditional Medicare and Medicare Advantage
Sidra Haye, Mireille Jacobson, Julie Zissimopoulos. Alzheimer's & Dementia, 2025
Topic: Risk, prevention and care in population studies
Abstract INTRODUCTION This paper quantifies how incident dementia diagnosis rates vary for similar beneficiaries in traditional Medicare (TM) and Medicare Advantage (MA) seen by the same primary care provider (PCP). METHODS This cohort analysis used 2016 to 2018 data for Medicare beneficiaries. Using a propensity score‐matched sample of beneficiaries with similar likelihood of MA enrollment, we estimated linear probability models with PCP fixed effects of incident dementia diagnosis in 2017 for beneficiaries in MA relative to beneficiaries in TM. RESULTS Among a matched sample of 15,410,030 beneficiaries, accounting for both provider and patient characteristics, the incident dementia diagnosis rate was 0.11 percentage points lower for MA beneficiaries compared to TM beneficiaries attributed to the same PCP. MA patients were less likely to be seen by dementia specialists. DISCUSSION Differences in system‐level factors such as access to dementia specialists is a contributing factor to differences in diagnosis rates in MA and TM. Highlights In this study, we quantify how incident dementia diagnosis rates vary for similar beneficiaries in TM and MA seen by the same PCP. To investigate the role of insurance design on dementia diagnosis, we examined differences in diagnosis rates for TM and MA beneficiaries seen by the same PCP. Among a matched sample of TM and MA beneficiaries with assigned PCPs in 2017, incident dementia diagnosis rates were 0.11 percentage points lower for MA beneficiaries compared to TM beneficiaries seen by the same PCP. MA patients were less likely to be seen by dementia specialists compared to TM beneficiaries seen by the same PCP.
Key findings
- RESULTS Among a matched sample of 15,410,030 beneficiaries, accounting for both provider and patient characteristics, the incident dementia diagnosis rate was 0.11 percentage points lower for MA beneficiaries compared to TM beneficiaries attributed to the same PCP.
- Among a matched sample of TM and MA beneficiaries with assigned PCPs in 2017, incident dementia diagnosis rates were 0.11 percentage points lower for MA beneficiaries compared to TM beneficiaries seen by the same PCP.
- MA patients were less likely to be seen by dementia specialists compared to TM beneficiaries seen by the same PCP.
Why it matters
Among a matched sample of over 15 million beneficiaries, the incident dementia diagnosis rate was 0.11 percentage points lower for Medicare Advantage beneficiaries than for traditional Medicare beneficiaries seen by the same primary care provider. Medicare Advantage patients were also less likely to be seen by dementia specialists.
Study details
- Evidence strengthModerate
How this study scored 42/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 27 of the 64 points we could judge it on, which is 42 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & Dementia) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 27 / 64 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 27 of the 64 points we could judge it on is 42 out of 100. |
| Total | 42 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Haye, S., Jacobson, M., & Zissimopoulos, J. (2025). Role of PCPs in diagnosing dementia in traditional Medicare and Medicare Advantage. Alzheimer's & Dementia. https://doi.org/10.1002/alz.14559
Vancouver
Haye S, Jacobson M, Zissimopoulos J. Role of PCPs in diagnosing dementia in traditional Medicare and Medicare Advantage. Alzheimer's & Dementia. 2025. doi:10.1002/alz.14559.
BibTeX
@article{haye2025-52307b0b,
author = {Haye, Sidra and Jacobson, Mireille and Zissimopoulos, Julie},
title = {{Role of PCPs in diagnosing dementia in traditional Medicare and Medicare Advantage}},
journal = {Alzheimer's \& Dementia},
year = {2025},
doi = {10.1002/alz.14559},
url = {https://doi.org/10.1002/alz.14559}
}
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