Comparison of Cancer Care Delivery and Outcomes in Medicare Advantage with Traditional Medicare

Abstract

Objective: Determine the effect of Medicare insurance status on quality of care and survival in cancer patients.

Background: Nearly half of current Medicare beneficiaries now enroll in Medicare Advantage (MA) plans and there is limited understanding of how overall cancer care and outcomes vary in MA compared to Traditional Medicare (TM).

Methods: Medicare beneficiaries undergoing treatment for stage 1-4 lung, esophageal, gastric, pancreatic, colon, and rectal cancer from 2000-2019 in California were identified. Access, timeliness, guideline concordance and overall survival were compared between MA and TM.

Results: 170,537 Medicare beneficiaries were analyzed (cancer type: 62,161 lung, 5,518 esophageal, 6,856 gastric, 11,582 pancreatic, 66,742 colon, and 17,678 rectal). Compared to TM, patients in MA were equally likely, or for some cancers more likely, to receive guideline concordant care. But, enrollment in MA was associated with worse overall survival after adjusting for covariates (all cancer types, hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.02-1.04, P<0.001); most notable for lung (HR 1.04, 95% CI 1.02-1.06, P<0.001) and pancreatic (HR 1.10, 95% CI 1.05-1.15, P<0.001) cancer. Considering all cancer types together, the survival rates were particularly low for stage 4 cancer patients (HR 1.05, 95% CI 1.03-1.08, P<0.001).

Conclusions: Compared to TM, MA enrollment was associated with limited access to accredited centers for cancer care but similar odds of guideline concordant care. Nonetheless, MA plan enrollment was independently associated with worse survival for lung, and pancreatic cancer; with greatest disparity for patients with stage 4 cancers.

Keywords: access; guideline concordance; medicare advantage; survival disparity; traditional medicare.