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. 2019 Jan 21;19(1):54.
doi: 10.1186/s12913-018-3864-5.

Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

Melinda M Davis  1 , Paul Shafer  2 , Stephanie Renfro  3 , Kristen Hassmiller Lich  2 , Jackilen Shannon  4 , Gloria D Coronado  5 , K John McConnell  3 , Stephanie B Wheeler  6
Affiliations

Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

Melinda M Davis et al. BMC Health Serv Res. .

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.

Keywords: Accountable care organizations; Colorectal cancer; Disparities; Medicaid.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Oregon Health & Science University Institutional Review Board with a waiver of informed consent (IRB #8865).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Annual Observed CRC Testing Trajectories and Modality Used in Eligible Enrollees in 16 Medicaid ACOs, 2010–2014
See this image and copyright information in PMC

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