Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?
Accountable care organizations
Colorectal cancer
Disparities
Medicaid
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
21 Jan 2019
21 Jan 2019
Historique:
received:
09
07
2018
accepted:
28
12
2018
entrez:
23
1
2019
pubmed:
23
1
2019
medline:
13
4
2019
Statut:
epublish
Résumé
Health care reform is changing preventive services delivery. This study explored trajectories in colorectal cancer (CRC) testing over a 5-year period that included implementation of 16 Medicaid Accountable Care Organizations (ACOs, 2012) and Medicaid expansion (2014) - two provisions of the Affordable Care Act (ACA) - within the state of Oregon, USA. Retrospective analysis of Oregon's Medicaid claims for enrollee's eligible for CRC screening (50-64 years) spanning January 2010 through December 2014. Our analysis was conducted and refined April 2016 through June 2018. The analysis assessed the annual probability of patients receiving CRC testing and the modality used (e.g., colonoscopy, fecal testing) relative to a baseline year (2010). We hypothesized that CRC testing would increase following Medicaid ACO formation - called Coordinated Care Organizations (CCOs). A total of 132,424 unique Medicaid enrollees (representing 255,192 person-years) met inclusion criteria over the 5-year study. Controlling for demographic and regional factors, the predicted probability of CRC testing was significantly higher in 2014 (+ 1.4 percentage points, p < 0.001) compared to the 2010 baseline but not in 2012 or 2013. Increased fecal testing using Fecal Occult Blood Tests (FOBT) or Fecal Immunochemical Tests (FIT) played a prominent role in 2014. The uptick in statewide fecal testing appears driven primarily by a subset of CCOs. Observed CRC testing did not immediately increase following the transition to CCOs in 2012. However increased testing in 2014, may reflect a delay in implementation of interventions to increase CRC screening and/or a strong desire by newly insured Medicaid CCO members to receive preventive care.
Sections du résumé
BACKGROUND
BACKGROUND
Health care reform is changing preventive services delivery. This study explored trajectories in colorectal cancer (CRC) testing over a 5-year period that included implementation of 16 Medicaid Accountable Care Organizations (ACOs, 2012) and Medicaid expansion (2014) - two provisions of the Affordable Care Act (ACA) - within the state of Oregon, USA.
METHODS
METHODS
Retrospective analysis of Oregon's Medicaid claims for enrollee's eligible for CRC screening (50-64 years) spanning January 2010 through December 2014. Our analysis was conducted and refined April 2016 through June 2018. The analysis assessed the annual probability of patients receiving CRC testing and the modality used (e.g., colonoscopy, fecal testing) relative to a baseline year (2010). We hypothesized that CRC testing would increase following Medicaid ACO formation - called Coordinated Care Organizations (CCOs).
RESULTS
RESULTS
A total of 132,424 unique Medicaid enrollees (representing 255,192 person-years) met inclusion criteria over the 5-year study. Controlling for demographic and regional factors, the predicted probability of CRC testing was significantly higher in 2014 (+ 1.4 percentage points, p < 0.001) compared to the 2010 baseline but not in 2012 or 2013. Increased fecal testing using Fecal Occult Blood Tests (FOBT) or Fecal Immunochemical Tests (FIT) played a prominent role in 2014. The uptick in statewide fecal testing appears driven primarily by a subset of CCOs.
CONCLUSIONS
CONCLUSIONS
Observed CRC testing did not immediately increase following the transition to CCOs in 2012. However increased testing in 2014, may reflect a delay in implementation of interventions to increase CRC screening and/or a strong desire by newly insured Medicaid CCO members to receive preventive care.
Identifiants
pubmed: 30665396
doi: 10.1186/s12913-018-3864-5
pii: 10.1186/s12913-018-3864-5
pmc: PMC6341697
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
54Subventions
Organisme : NCI NIH HHS
ID : K07 CA211971
Pays : United States
Organisme : AHRQ HHS
ID : K12 HS022981
Pays : United States
Organisme : ACL HHS
ID : U48DP005017
Pays : United States
Organisme : NCCDPHP CDC HHS
ID : 1NU58DP006083
Pays : United States
Organisme : NCI NIH HHS
ID : K07CA211971
Pays : United States
Références
Med Care. 2016 May;54(5):466-73
pubmed: 27078821
JAMA. 2017 Jan 24;317(4):388-406
pubmed: 28118455
Prev Med. 2017 Aug;101:44-52
pubmed: 28506715
JAMA. 2011 May 25;305(20):2096-104
pubmed: 21610242
Cancer Epidemiol Biomarkers Prev. 2014 Nov;23(11):2512-21
pubmed: 25155759
Health Aff (Millwood). 2017 Mar 1;36(3):451-459
pubmed: 28264946
Find Brief. ;42(7):1-2
pubmed: 27845832
Health Aff (Millwood). 2010 Aug;29(8):1498-506
pubmed: 20679654
Ann Intern Med. 2010 May 18;152(10):668-76
pubmed: 20388703
J Rural Health. 2015 Summer;31(3):254-68
pubmed: 25599819
Healthc (Amst). 2014 Sep;2(3):163-167
pubmed: 25540719
Ann Intern Med. 2008 Nov 4;149(9):638-58
pubmed: 18838718
Clin Gastroenterol Hepatol. 2013 May;11(5):526-33
pubmed: 23220166
JAMA. 2016 Jun 21;315(23):2564-2575
pubmed: 27304597
Prev Chronic Dis. 2019 Aug 15;16:E107
pubmed: 31418685
JAMA Intern Med. 2017 Apr 1;177(4):538-545
pubmed: 28192568
Breast Cancer Res Treat. 2012 May;133(1):333-45
pubmed: 22270934
Cancer Causes Control. 2018 Mar;29(3):363-369
pubmed: 29417296
MMWR Surveill Summ. 2017 Jul 07;66(14):1-13
pubmed: 28683054
Health Place. 2014 Sep;29:114-23
pubmed: 25063908
Cancer Epidemiol Biomarkers Prev. 2007 Oct;16(10):2118-27
pubmed: 17932360
JAMA. 2017 Jan 24;317(4):365-367
pubmed: 28118434
Am J Prev Med. 2017 Sep;53(3):335-344
pubmed: 28427954
Am J Med Sci. 2013 Feb;345(2):99-103
pubmed: 22814361
J Rural Health. 2018 Mar;34(2):202-212
pubmed: 28686787
Am J Prev Med. 2016 Feb;50(2):161-70
pubmed: 26497264
Cancer Med. 2012 Dec;1(3):350-6
pubmed: 23342284
Health Aff (Millwood). 2008 May-Jun;27(3):759-69
pubmed: 18474969
MMWR Morb Mortal Wkly Rep. 2013 Nov 8;62(44):881-8
pubmed: 24196665
Cancer. 2006 Oct 1;107(7):1624-33
pubmed: 16933324
J Rural Health. 2017 Sep;33(4):345-349
pubmed: 28905432
BMC Cancer. 2018 Jan 06;18(1):40
pubmed: 29304835
JAMA. 2016 Mar 1;315(9):869-70
pubmed: 26847402
Med Care. 2016 Mar;54(3):326-35
pubmed: 26759974
MMWR Morb Mortal Wkly Rep. 2017 Mar 03;66(8):201-206
pubmed: 28253225
Cancer. 2016 Sep 1;122(17):2739-46
pubmed: 27218198
Health Care Financ Rev. 2000 Spring;21(3):29-64
pubmed: 11481767
Prev Chronic Dis. 2017 Feb 23;14:E18
pubmed: 28231042