More than 40% of adults will develop cancer in their lives, with 58% of those cases appearing in people aged 65 and older. While many people 65 and older are insured through Medicare, they may face barriers to treatment due to coverage restrictions.
HPM Professor Lindsay Sabik, PhD and HPM Associate Professor Coleman Drake, PhD, have been awarded an R01 research grant from the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), to study barriers to care and identify possible solutions. R01 grants are highly competitive awards from the NIH for research that will have a significant impact on health.
Medicare Advantage (MA), which allows private insurers to provide coverage to Medicare enrollees, has grown to cover more than half of Medicare beneficiaries in recent years. While MA plans often have lower out-of-pocket costs and coverage for additional services, like dental and vision coverage, compared to traditional Medicare, they have limited provider networks.
“These tradeoffs may be particularly consequential for patients with cancer, who require complex, multimodal care and often benefit from treatment at specialized cancer hospitals like NCI-designated cancer centers,” said Sabik. “One recent estimate suggests 41% of MA plans in areas with an NCI-designated cancer center exclude that center from their networks, which can translate into real barriers for patients after a diagnosis.”
Despite the growth of MA coverage and evidence about the issues that coverage limitations raise, especially in specialty care, there has been little research into the effects of care access, quality and outcomes related to cancer.
“Medicare Advantage now covers roughly 54% of Medicare beneficiaries — about 34 million adults — yet we still have limited evidence on how it affects cancer care access, quality, and outcomes,” said Drake. “Our goal is to produce the first comprehensive picture of how coverage choices and network design shape treatment for patients with the four most prevalent cancers: breast, colorectal, lung, and prostate.”
Over the course of this project, Sabik and Drake will examine enrollment trends among patients with cancer who enroll in MA plans and how their treatment and care are affected . They will also compare the results with those of patients enrolled in traditional Medicare to see if there are significant differences in outcomes between the groups.
“By linking cancer registry data to Medicare claims and detailed network data, we can measure what patients actually experience — whether they reach a specialized cancer hospital, how quickly they start treatment, and whether they receive guideline-concordant care,” said Sabik. “The evidence we generate is intended to inform decision makers working to ensure timely, high-quality cancer care for everyone in Medicare.”
- Mike Friend