Recommended cancer screening in accountable care organizations: trends in colonoscopy and mammography in the medicare shared savings program

Authors

Alexander P. Cole, Brigham and Women's Hospital, Boston, MA
Anna Krasnova, Brigham and Women's Hospital, Boston, MA
Ashwin Ramaswamy, Brigham and Women's Hospital, Boston, MA
Sean A. Fletcher, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
David F. Friedlander, Brigham and Women's Hospital, Boston, MA
Julia McNabb-Baltar, Brigham and Women's Hospital, Boston, MA
Nelya Melnitchouk, Brigham and Women's Hospital, Boston, MA
Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA
Maxine Sun, Brigham and Women's Hospital, Boston, MA
Adam S. Kibel, Brigham and Women's Hospital, Boston, MA
Mehra Golshan, Brigham and Women's Hospital, Boston, MA
Adil H. Haider, Aga Khan UniversityFollow

Document Type

Article

Department

General Surgery

Abstract

Purpose: Accountable care organizations (ACOs) are a delivery and payment model designed to encourage integrated, high-value care. We designed a study to test the association between ACOs and two recommended cancer screening tests, colonoscopy for colorectal cancer and mammography for breast cancer.
Method: Using the random 20% sample of Medicare claims, beneficiaries were attributed to ACO or non-ACO cohorts on the basis of providers’ enrollment in the Medicare Shared Savings Program. An inverse probability of treatment weighting was used to balance patient characteristics between ACO and non-ACO cohorts. A propensity score–weighted, difference-in-differences analysis was then performed using the same provider groups in 2010—pre-ACO—as a baseline. A secondary analysis for older—nonrecommended—age ranges was performed.
Result: Prevalence of colonoscopy in recommended age ranges in ACOs from 2010 to 2014 increased from 15.3% (95% CI, 14.9% to 15.6%) to 17.9% (95% CI, 17.3% to 18.5%). This differed significantly from the change in non-ACOs (difference in differences, 1.2%; P < .001). Among women in ACOs, mammography prevalence rose from 53.7% (95% CI, 53.0% to 54.4%) to 54.9% (95% CI, 54.2% to 55.7%). In contrast to colonoscopy, the difference in mammography prevalence was not significantly different in ACO versus non-ACOs (difference in differences, 0.49%; P < .13). A similar pattern was also observed in older—nonrecommended—age ranges with significant difference in differences (ACO v non-ACO) in colonoscopy, but not mammography.
Conclusion: The impact of ACOs on cancer screening varies between screening tests. Our results are consistent with a greater effect of ACOs on high-cost, high-complexity screening services, which may be more sensitive to integrated care delivery models.

Publication (Name of Journal)

Journal of Oncology Practice

Recommended Citation

Cole, A. P., Krasnova, A., Ramaswamy, A., Fletcher, S. A., Friedlander, D. F., McNabb-Baltar, J., Melnitchouk, N., Lipsitz, S. R., Sun, M., Kibel, A. S., Golshan, M., Haider, A. H. (2019). Recommended cancer screening in accountable care organizations: trends in colonoscopy and mammography in the medicare shared savings program. Journal of Oncology Practice, 15(6), e547-e559.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/178