Mixed Outcomes Persist Between MA, FFS Beneficiaries: Johnie Rose, MD, PhD

In an interview with The American Journal of Managed Care® (AJMC®), Johnie Rose, MD, PhD, associate professor at Case Western Reserve University School of Medicine, discusses the continued growth of Medicare Advantage (MA) enrollment and the mixed results of research comparing outcomes between MA and fee-for-service (FFS) Medicare enrollees.

He also outlined the goals of his study, "Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage," published in this month's issue of AJMC.

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

Transcript

How has MA enrollment evolved in recent years? Are there known differences in outcomes between MA and FFS Medicare enrollees?

This has been something that's been studied in dozens of studies over the years, not specific to cancer but in general. The important thing to remember is that the context keeps changing because enrollment does keep growing.

We just passed the 50% mark in 2023, more than half of Medicare enrollees are enrolled in a Medicare Advantage plan. The clip of enrollees who are Black has been higher than for White Americans, similarly for Hispanic and Asian enrollees. For the non-White groups, enrollment has been growing faster. The composition of who's in Medicare Advantage keeps changing.

The different studies that have looked at this have not provided clean, clear answers. They've looked at lots of different outcomes, both hard and soft endpoints, in terms of re-enrollment, things like that. They're easily documented from claims data and patient-reported outcomes; there is no definitive answer.

Some studies show that folks do better in Medicare Advantage plans, while some studies show that Black patients, who are the main group studied, Black and White, do less well, some show that they do better, some show that there's no difference at all.

Again, there's not a lot of data about cancer, but the bottom line is that enrollment keeps going, and it's expected to be 60% by 2030. The makeup of who's in MA keeps changing, so it's important to continue looking.

What was the objective of your study? Why did you decide to investigate this?

The objective of our study was to compare 3 main outcomes, so the receipt of standard treatment for women with breast cancer in Ohio. That standard treatment was defined as receiving either (this is for stage 1 to 3 breast cancer) mastectomy or lumpectomy plus radiation. There was a partial mastectomy with radiation follow-up, so it was an indicator of whether or not the patient received that.

The time to treatment, so what was the gap in days between the time of diagnosis and when treatment was started? Then, the overall survival. We were comparing this between fee-for-service and Medicare Advantage patients in Ohio, using Ohio's cancer registry data that collects information on all cancer diagnoses in the state linked with Medicare claims data.

Breast cancer outcomes have been shown to be particularly subject to disparities in terms of differences between races, differences between individuals in different socioeconomic classes. For example, while incidences tend to be higher among White women, mortality tends to be much, much higher among Black women.

These outcomes between fee-for-service and Medicare Advantage haven't been examined very much in cancer generally, so breast cancer was a good place to start. I don't think it's necessarily the only disease we should be looking at, but it was a good place to start. It's a common cancer, and there are no disparities.