No Significant Differences Found in Breast Cancer Treatment Between MA, FFS Beneficiaries: Galen Shearn-Nance, BS

In part 2 of this interview, Galen Shearn-Nance, BS, lead investigator and a fourth-year medical student at Case Western Reserve University, highlights key findings from 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^®.

Watch part 1 to learn more about the study's background and objectives from Johnie Rose, MD, PhD, one of the authors and an associate professor at Case Western Reserve University School of Medicine.

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

Transcript

Can you discuss the main findings? Were there any that surprised you?

We found no significant difference between Medicare Advantage and fee-for-service patients for these women with breast cancer, in terms of their odds of receiving standard treatment, the amount of time to treatment initiation, or their overall survival. As Dr Rose alluded to, there's a large body of research looking at differences in outcomes between Medicare Advantage and fee-for-service, but it's a really mixed bag as far as what the results look like. I think, in that sense, it wasn't necessarily a surprise because knowing that the literature is so murky on this, I don't think we necessarily were going in feeling strongly that we would find a stark difference.

To our knowledge, this is the first study that directly compares mortality as a primary end point for cancer patients between fee-for-service and Medicare Advantage patients. There are, as Dr Rose mentioned, lots of studies looking at different outcomes, but mortality, specifically, there are actually not very many studies looking at mortality. There was one study that we found looking at inpatient mortality for patients with heart attack, but none specifically in cancer.

This was also the first study, to our knowledge, looking at receipt of standard treatment and time to treatment initiation for cancer patients between fee-for-service and Medicare Advantage.

The study found that Black patients with fee-for-service Medicare were less likely to receive standard treatment. What factors do you believe may be contributing to this disparity?

It's a really good question, and one that we don't necessarily have a strong conclusion for. There's a couple of factors at play here that we think could be playing a role in this disparity.

Medicare Advantage plans are required to have an out-of-pocket maximum. If it's true that Black patients have fewer financial resources overall, then this finding may stem from the fact that there is a little bit more financial protection baked into the Medicare Advantage plans, insulating patients from some of the financial toxicity and challenges associated with continuing their cancer treatment.

Within our study, we tried to control for income by using census tract poverty, but that's a fairly crude metric. We really only captured whether an individual was or wasn't living in a neighborhood with either greater than 20% or less than 20% poverty rates. There's a significant amount of nuance that maybe isn't quite detected there.

Another point, with Black patients, there is prior research which shows that Black patients and fee-for-service plans are less likely to have supplemental Medigap coverage. That supplemental Medigap coverage, again, can impact access to care and treatment outcomes, so this could be another factor.

Lastly, a point which we mentioned in the discussion of our paper, there is some research that shows that Black patients may have access to lower quality Medicare Advantage plans. There's a wide range of different Medicare Advantage plans that exist, and there was some research that was published, which showed that neighborhoods primarily populated by Black patients often had access to a larger number of Medicare Advantage plans, but they were less likely to be highly rated Medicare Advantage plans. That nuance, again, may be something that we can't necessarily get insight into.