Medicare ACO Enrollment Improves Quality of Breast, Colorectal Cancer Screening


Widespread use of alternative payment models may improve the quality of breast and colorectal cancer screening programs, according to an investigation published in JAMA Internal Medicine (online March 19, 2018; doi:10.1001/jamainternmed.2017.8087).

In recent years, there has been a rapid uptake in Accountable Care Organizations (ACOs) in the United States. However, whether ACO enrollment results in observable changes in cancer screening remains unclear.

Matthew J Resnick, MD, MPH, MMHC, Vanderbilt University Medical Center, and colleagues conducted a population-based analysis to determine whether Medicare Shared Savings Program (MSSP) ACO enrollment impacted the appropriateness of screening for breast, colorectal, and prostate cancer. Researchers used Medicare data from 2007 through 2014 and assessed changes in screening associated with ACO enrollment by utilizing differences-in-differences analyses. Further difference-in-difference-in-differences analyses were performed to determine whether changes in cancer screening associated with ACO enrollment were different across strata of appropriateness, which was pre-defined using age (65-74 years vs ≥ 75 years) and predicted survival (top vs bottom quartile).

Researchers reported that among Medicare beneficiaries, breast cancer screening declined in both ACO and non-ACO populations. The adjusted rate of decline—as determined by differences-in-differences analyses—in the ACO population exceeded the non-ACO population by 0.79%. Additionally, researchers noted that this decline was most prominent among older women.

In the colorectal cancer population, baseline screening rates were lower than those for breast cancer among both ACO and non-ACO cohorts. Researchers noted an adjusted 0.24% increase in screening associated with ACO enrollment, which was most prominent among younger Medicare beneficiaries.

For breast and colorectal cancer, researchers observed statistically significant differences in estimates of effect between age strata, suggesting that the ACO effect on cancer screening is mediated by age.


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Conversely, researchers acknowledged that ACO enrollment was linked with significant reductions in prostate cancer screening, regardless of age or predicted survival.

Dr Resnick and colleagues concluded that Medicare ACO enrollment results in improvements in appropriateness of breast and colorectal cancer screening by targeting screening to patients most likely to benefit and withholding screening for those who are not likely to benefit. “The magnitude of effect is modest in the early ACO experience,” authors of the study wrote, noting that “further investigation will characterize the most meaningful levers to optimize cancer screening programs in the United States.”—Zachary Bessette