Investigators Advocate for Ongoing Comparison of Cancer Outcomes Among MA, FFS Beneficiaries

In the final part of this interview, Galen Shearn-Nance, BS, lead investigator and a fourth-year medical student at Case Western Reserve University, acknowledges the limitations of his study, "Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage," published in this month's issue of The American Journal of Managed Care^®.

Johnie Rose, MD, PhD, coauthor, associate professor at Case Western Reserve University School of Medicine, concludes by outlining key areas for future research based on their findings.

Watch parts 1 and 2 for insights into the study's objectives and results.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What were the key limitations of your study? How might they have impacted your findings?

First off, we're focusing entirely on patients in Ohio, so it's possible that the results are not generalizable to other regions with different health care infrastructures, although I think Ohio is relatively representative of much of the country. While that is a limitation, I think it's probably generalizable.

We're also only looking at breast cancer patients, and treatment for breast cancer is fairly standardized. There are published guidelines, and there's typically a pretty standardized approach to the treatment, so it's possible that some of our findings are less applicable to other cancer types.

Lastly, one limitation is that we don't have any data on whether patients are not receiving standard treatment due to a failure of the health system, or due to a clinical decision where the patient is deemed medically ineligible, or something like that. This is a point that we touch on briefly, in that one of our findings was that we saw deviation from standard treatment increasing with age of diagnosis.

One reason that this may be the case is that, because of the results of a study back in 2004 on outcomes for women with breast cancer, oncologists will often omit radiation therapy in this patient population. Within our methodology, we see this as not receiving standard care, so it's possible for certain patients.

I did say that treatment for breast cancer is fairly standardized, but it's possible that, on the margins, with certain cases that don't quite fit the typical treatment workflow, we detect that as not receiving standard treatment.

What additional research is needed to further understand cancer care quality among Medicare beneficiaries?

The Medicare Advantage population is not static. The enrollment is growing, the makeup of enrollees is growing. Nor are the plans themselves static, from the standpoint of the benefits being offered and the regional access to plans. I think it's going to be important to continually look at this issue.

I think of it almost as doing surveillance, like we would for the flu or something like that. We need to keep looking at this periodically. We can look at other cancer types, we can look more broadly geographically. This could include using Medicare data linked to the SEER [Surveillance, Epidemiology, and End Results] cancer registry data, which covers about half of the population. We could definitely get more of a generalizable signal from a larger group of people by doing that.

I think it's going to be important to better understand differences in financial toxicity between fee-for-service and Medicare [Advantage]. The traditional criticism has been that MA [Medicare Advantage] plans have cherry-picked patients, [and] that they've left higher-risk patients, who often tend to be poorer patients, out of their enrollment. This is one of the ways that they've reportedly remained profitable.

I think an aspect that needs to to be considered, though, is the potential benefits, especially if we can reduce any sort of bias or differential access based on race and income. There's a real argument to be made that there can be benefits of having these financial protections in place, particularly from the out-of-pocket maximums. There's a lot there to look at, and some of that could also inform policy, it could inform benefit design; so, much work to do, still.