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.
| Original language | English (US) |
|---|---|
| Number of pages | 1 |
| Journal | BMC Health Services Research |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 21 2019 |
Fingerprint
Keywords
- Accountable care organizations
- Colorectal cancer
- Disparities
- Medicaid
ASJC Scopus subject areas
- Health Policy
Cite this
Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing? / Davis, Melinda; Shafer, Paul; Renfro, Stephanie; Hassmiller Lich, Kristen; Shannon, Jackilen (Jackie); Coronado, Gloria D.; McConnell, Kenneth (John); Wheeler, Stephanie B.
In: BMC Health Services Research, Vol. 19, No. 1, 21.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?
AU - Davis, Melinda
AU - Shafer, Paul
AU - Renfro, Stephanie
AU - Hassmiller Lich, Kristen
AU - Shannon, Jackilen (Jackie)
AU - Coronado, Gloria D.
AU - McConnell, Kenneth (John)
AU - Wheeler, Stephanie B.
PY - 2019/1/21
Y1 - 2019/1/21
N2 - 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.
AB - 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.
KW - Accountable care organizations
KW - Colorectal cancer
KW - Disparities
KW - Medicaid
UR - http://www.scopus.com/inward/record.url?scp=85060209484&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060209484&partnerID=8YFLogxK
U2 - 10.1186/s12913-018-3864-5
DO - 10.1186/s12913-018-3864-5
M3 - Article
C2 - 30665396
AN - SCOPUS:85060209484
VL - 19
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
ER -