Detection and treatment of breast cancer in dually enrolled Medicare-Medicaid beneficiaries in accountable care organizations

Compared to the general population, dually enrolled Medicare-Medicaid beneficiaries (“duals”) have worse breast cancer outcomes: duals are less likely to be screened and to have timely treatment. In addition, duals with cancer have been found to have costlier annual health care expenditures. Such costly care is important to consider for a population that is disproportionately costly for Medicare and Medicaid, a population accounting for one-third of each program’s budget despite only consisting of 15-20% of their beneficiaries. Accountable care organizations (ACOs) may provide a higher quality of cancer-related care while containing costs. Previous studies have demonstrated a modest increase in breast cancer screening rates and a reduction in low-value breast cancer screening in ACOs. Prior work has shown ACO beneficiaries report timelier access to care and savings generated for cancer patients in an ACO. Yet, to date, no study has directly examined whether ACOs improve breast cancer outcomes for duals. To address this gap in literature, I assess the breast cancer care continuum for duals from screening to treatment initiation and expenditures. In Aim 1, I determine the effect of ACOs on the likelihood of being screened for breast cancer. In Aim 2, I study the time to treatment initiation for ACO beneficiaries after a breast cancer diagnosis. In Aim 3, I assess Medicare spending for ACO beneficiaries with breast cancer in the first year after diagnosis. Results from this study show that ACOs have a modest impact in increasing the probability of being screened. Meanwhile, I was unable to observe any statistically significant difference in time to treatment initiation and Medicare spending for duals with breast cancer in the first year of their diagnosis. Altogether, these study findings suggest that early ACO models may not have the infrastructure or incentives to motivate better breast cancer outcomes for duals.