1. Effects of Medicaid managed care on early detection of cancer: Evidence from mandatory Medicaid managed care program in Pennsylvania
- Author
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Kwon, Youngmin, Roberts, Eric T., Cole, Evan S., Degenholtz, Howard B., Jacobs, Bruce L., and Sabik, Lindsay M.
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Discrimination in medical care ,Oncology, Experimental ,Medical care, Cost of ,Cancer -- Diagnosis -- Research ,Medicaid ,Health care industry ,Cost control ,Health care disparities ,Managed care plans (Medical care) ,Tumor staging ,Health care industry ,Company business management ,Cost reduction ,Business - Abstract
Objective: To examine changes in late- versus early-stage diagnosis of cancer associated with the introduction of mandatory Medicaid managed care (MMC) in Pennsylvania. Data Sources and Study Setting: We analyzed data from the Pennsylvania cancer registry (2010-2018) for adult Medicaid beneficiaries aged 21-64 newly diagnosed with a solid tumor. To ascertain Medicaid and managed care status around diagnosis, we linked the cancer registry to statewide hospital-based facility records collected by an independent state agency (Pennsylvania Health Care Cost Containment Council). Study Design: We leveraged a natural experiment arising from county-level variation in mandatory MMC in Pennsylvania. Using a stacked difference-in-differences design, we compared changes in the probability of late-stage cancer diagnosis among those residing in counties that newly transitioned to mandatory managed care to contemporaneous changes among those in counties with mature MMC programs. Data Collection/Extraction Methods: N/A. Principal Findings: Mandatory MMC was associated with a reduced probability of late-stage cancer diagnosis (-3.9 percentage points; 95% CI: -7.2, -0.5; p = 0.02), particularly for screening-amenable cancers (-5.5 percentage points; 95% CI: -10.4, -0.6; p = 0.03). We found no significant changes in late-stage diagnosis among non-screening amenable cancers. Conclusions: In Pennsylvania, the implementation of mandatory MMC for adult Medicaid beneficiaries was associated with earlier stage of diagnosis among newly diagnosed cancer patients with Medicaid, especially those diagnosed with screening-amenable cancers. Considering that over half of the sample was diagnosed with late-stage cancer even after the transition to mandatory MMC, Medicaid programs and managed care organizations should continue to carefully monitor receipt of cancer screening and design strategies to reduce barriers to guideline-concordant screening or diagnostic procedures. KEYWORDS cancer early detection, cancer staging, health services accessibility, healthcare disparities, managed care, medicaid, national program of cancer registries What is known on this topic * Medicaid covers a growing population of individuals with cancer but Medicaid beneficiaries with cancer often experience poor survival due to late-stage diagnosis. * Medicaid managed care is the predominant model for administering Medicaid services and benefits and may influence early cancer detection through care coordination, screening, and primary care management. * Existing studies of Medicaid managed care indicate mixed findings regarding effects of managed care on care access and utilization among adult Medicaid beneficiaries, and only a few have examined cancer-related outcomes. What this study adds * Using a difference-in-differences design, we examined the effects of mandatory Medicaid managed care in Pennsylvania on early versus late-stage diagnosis of incident cancer cases among adult patients aged 21-64 covered by Medicaid. * In Pennsylvania, Medicaid managed care was associated with earlier detection of cancer among Medicaid-insured cases, especially those diagnosed with screening-amenable cancers., 1 | INTRODUCTION Medicaid is an important source of health insurance coverage for low-income individuals with cancer. (1) After the Affordable Care Act (ACA)'s implementation, uninsurance among individuals newly diagnosed [...]
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- 2024
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