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Managed care organizations tend to shy away from rigid management of patients with cancer, owing to the number of acceptable regimens for various tumors, the difficulty in controlling the use of oncologic (particularly biologic) agents, and the fact that prior authorization requests are rarely denied in these patients.
Medicare Advantage plans use a variety of tools to manage costs associated with treatment, including restricted provider choice and utilization management. However, managed care organizations tend to shy away from rigid management of patients with cancer, owing to the number of acceptable regimens for various tumors, the difficulty in controlling the use of oncologic (particularly biologic) agents, and the fact that prior authorization requests are rarely denied in these patients.
Analysts from Memorial Sloan-Kettering Cancer Center in New York and the Centers for Medicare and Medicaid Services in Baltimore evaluated the voluntary enrollment rates from more than 100,000 patients with cancer diagnoses in Medicare managed care programs compared with those without a cancer diagnosis. These patients were matched to enrollees without cancer with regard to age, sex, race, and geographic location. All patient data were over a seven-year period, ending December 2002.
They evaluated the disenrollment behavior of patients with breast, colorectal, prostate, or lung cancer 2 years after their diagnosis. Interestingly, they found that patients in managed Medicare plans (now known as Medicare Advantage plans) were considerably less likely to leave the plan compared with members without cancer. Analysis across numerous variables, including cancer stage, age, and race did not reveal contrary results. The mean hazard ratios for disenrollment ranged from 0.78 for patients with breast cancer to 0.86 for prostate cancer.
It seems that patients with cancer were satisfied with their managed care Medicare plans. It should be pointed out that in the nearly seven years since the data were collected, the Medicare Advantage and Medicare Part D programs have changed the managed Medicare environment. However, in most cases, this has increased access to care and medications, and it might actually decrease enrollment rates.
Elkin EB, Ishill N, Riley GF, et al. Disenrollment from Medicare managed care among beneficiaries with and without a cancer diagnosis.
J Natl Cancer Inst.