Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Accountable Care Organizations* ; Early Detection of Cancer* ; Medicaid*; Colorectal Neoplasms/*diagnosis; Aged ; Female ; Health Care Reform ; Humans ; Insurance Claim Review ; Male ; Middle Aged ; Oregon ; Patient Acceptance of Health Care ; Patient Protection and Affordable Care Act ; Retrospective Studies ; United States
    • Abstract:
      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: 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: 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: 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.
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    • Grant Information:
      K07 CA211971 United States CA NCI NIH HHS; K12 HS022981 United States HS AHRQ HHS; U48DP005017 United States ACL ACL HHS; 1NU58DP006083 United States DP NCCDPHP CDC HHS; K07CA211971 United States CA NCI NIH HHS
    • Contributed Indexing:
      Keywords: Accountable care organizations; Colorectal cancer; Disparities; Medicaid
    • Publication Date:
      Date Created: 20190123 Date Completed: 20190412 Latest Revision: 20231005
    • Publication Date:
      20240105
    • Accession Number:
      PMC6341697
    • Accession Number:
      10.1186/s12913-018-3864-5
    • Accession Number:
      30665396