Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies

BMC Health Services Research

Yifan Gu¹  Bonnie K. Lind²  Sarah E. Bartelmann³  Kristen Hassmiller Lich⁴  Meghan C. O’Leary⁴  Stephanie B. Wheeler⁵  Maria E. Mayorga⁶  Gloria D. Coronado⁷  Melinda M. Davis⁸ 

[1]Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA

[2]Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA

[3]OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA

[4]Center for Outcomes Research and Education, Portland, OR, USA

[5]Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavran-Greenberg Hall, 27599, Chapel Hill, NC, USA

[6]Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavran-Greenberg Hall, 27599, Chapel Hill, NC, USA

[7]Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

[8]Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

[9]Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA

[10]Kaiser Permanente Center for Health Research, Portland, OR, USA

[11]OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA

[12]Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA

[13]Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA

关键词: Colorectal Cancer;    Health Policy;    Health Promotion;    Medicaid;    Screening;   

DOI  :  10.1186/s12913-019-4113-2

来源: Springer

【 摘 要 】

BackgroundColorectal cancer (CRC) screening is underutilized by Medicaid enrollees and the uninsured. Multiple national and state policies were enacted from 2010 to 2014 to increase access to Medicaid and to promote CRC screening among Medicaid enrollees. We aimed to determine the impact of these policies on screening initiation among newly enrolled Oregon Medicaid beneficiaries age-eligible for CRC screening.MethodsWe identified national and state policies affecting Medicaid coverage and preventive services in Oregon during 2010–2014. We used Oregon Medicaid claims data from 2010 to 2015 to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening (a prevention milestone, and an age at which guideline-concordant screening can be assessed within a single year) during each year from 2010 to 2014. We calculated risk ratios to assess whether first year of Medicaid enrollment and/or year turned 50 was associated with CRC screening initiation.ResultsWe identified 14,576 Oregon Medicaid enrollees who turned 50 during 2010–2014; 2429 (17%) completed CRC screening within 12 months after turning 50. Individuals newly enrolled in Medicaid in 2013 or 2014 were 1.58 and 1.31 times more likely, respectively, to initiate CRC screening than those enrolled by 2010. A primary care visit in the calendar year, having one or more chronic conditions, and being Hispanic was also associated with CRC screening initiation.DiscussionThe increased uptake of CRC screening in 2013 and 2014 is associated with the timing of policies such as Medicaid expansion, enhanced federal matching for preventive services offered to Medicaid enrollees without cost sharing, and formation of Medicaid accountable care organizations, which included CRC screening as an incentivized quality metric.

【 授权许可】

CC BY