New study shows Medicaid expansion associated with increase in palliative care for patients with advanced cancers
IMAGE: MORE PEOPLE WITH ADVANCED CANCERS IN THE UNITED STATES RECEIVED CRITICAL PALLIATIVE CARE SERVICES, ACCORDING TO NEW FINDINGS BY RESEARCHERS AT THE AMERICAN CANCER SOCIETY. view more
CREDIT: AMERICAN CANCER SOCIETY
ATLANTA, July 5, 2023 – More people with advanced cancers in the United States received critical palliative care services, according to new findings by researchers at the American Cancer Society (ACS). Palliative care includes supportive care managed by a healthcare team, such as relief from symptoms, pain, and stress. Researchers also found where a patient lives in the U.S. may determine their use of palliative care. Medicaid expansion under the ACA was associated with the largest increases in palliative care use. The study was published today in the July issue of the journal Health Affairs.
“Our findings are encouraging, especially with growing evidence of the important benefits of palliative care for patients with cancer,” said Dr. Xuesong Han, lead author of the study and scientific director of health services research at the American Cancer Society. “It’s imperative to know how to target ways to increase access to these services, as use, overall, still remains low in the U.S.”
For the study, researchers examined data from the National Cancer Database, a national hospital-based cancer registry jointly sponsored by the American College of Surgeons and ACS. Scientists included data from people aged 18-64 years newly diagnosed with stage IV cancers in 2010-2019.
Researchers discovered the number of eligible patients who received palliative care increased from 17.0 percent pre-expansion to 18.9 percent post-expansion in Medicaid expansion states and from 15.7 percent to 16.7 percent in non-expansion states. The study also showed palliative care associated with Medicaid expansion was largest for patients with advanced pancreatic, colorectal, lung, and oral cavity and pharynx cancers, and non-Hodgkin lymphoma.
“These study results suggest that the expansion of Medicaid coverage may increase palliative care use,” added Han. “They also point to a potentially widening geographic disparity in receipt of guideline-recommended palliative care between states with different health policies regarding income-based Medicaid eligibility requirements.”
“Research continues to underscore the impact increasing access to comprehensive, affordable health insurance through Medicaid has on cancer patient survival and the further importance of providing greater access to palliative care services to those positive outcomes. The American Cancer Society Cancer Action Network (ACS CAN) has led legislation in states to support palliative care access and continues to advocate for legislation at the federal level to promote increased access to supportive care at any age or stage of diagnosis nationwide,” said Lisa Lacasse, President of ACS CAN. “To fully improve patient quality of life, Congress should prioritize legislation that educates patients and providers about the availability and benefits of palliative care and expand federal palliative care research. It’s also crucial all remaining states expand access to Medicaid as access to comprehensive health care is key to closing the gap on the health inequities we see in these underserved areas and ensure everyone has a fighting chance against cancer.”
Other ACS authors participating in this study include: Sylvia Shi, Jingxuan Zhao, Dr. Leticia Nogueira, Dr. Arif Kamal, Dr. Ahmedin Jemal, and Dr. Robin Yabroff.
For additional information on palliative care services, visit here at cancer.org.
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About the American Cancer Society
The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 100 years, we have been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. We are committed to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook, Twitter, and Instagram.
JOURNAL
Health Affairs]
Study finds scant coverage for seniors’
mental health care
Narrow psychiatrist networks for Medicare Advantage highlight lack of access for mental health
Peer-Reviewed PublicationAmid heightened demand for mental health care, a new study finds that nearly two-thirds of Medicare Advantage psychiatrist networks contain less than 25% of all psychiatrists in a given service area.
“This means that many people who have coverage through Medicare Advantage plans may not actually have access to psychiatrists, given how few are considered in-network,” said lead author Jane Zhu, M.D., assistant professor of medicine (general internal medicine and geriatrics) in the School of Medicine at Oregon Health & Science University.
The research published today in the July issue of the journal Health Affairs.
Medicare is the federal health insurance program for people who are 65 or older. Medicare Advantage, which covers 28 million Americans through private insurance plans backed by Medicare, has an even narrower network of psychiatrists available to patients than those covered by Medicaid managed care or by insurance plans in the Affordable Care Act. Insurance plans often contract with sets of providers — considered “in-network” — to deliver services to their enrollees.
The researchers built a nationwide data set of health plan networks, their service areas and their participating providers in 2019.
The new study is the latest in a series of findings highlighting a lack of coverage and access to mental health care nationwide. Provider networks are one important lever of access, and Zhu noted that the new study likely understates the problem.
“It’s likely a rosier picture than reality,” Zhu said. “We know the actual number of psychiatrists available to see patients is much lower.”
That’s because even if a psychiatrist is technically in-network, Zhu said an overall national shortage of psychiatrists means that many are fully booked already and aren’t accepting new patients. She said this may translate to higher out-of-pocket costs, delays in care, or foregone treatment.
For Zhu, these findings suggest that it’s necessary for insurers to incentivize more psychiatrists and mental health professionals to accept health insurance, or to expand coverage of services delivered by other health care professionals such as psychologists, counselors or primary care physicians who provide mental health care.
In some areas examined in this latest study, the picture was even more dire, with not a single psychiatrist who accepts Medicare Advantage insurance accepting patients.
“More than half of the counties for which we had data did not have a single [Medicare Advantage]-participating psychiatrist,” the authors write. “Our findings offer upper-bound estimates of network breadth, raising concerns about MA enrollees’ access to mental health services amid the growing prevalence of mental health conditions among older adults.”
In addition to Zhu, co-authors included Mark Katz Meiselbach, Ph.D., and Daniel Polsky, Ph.D., of Johns Hopkins University, and Coleman Drake, Ph.D., of the University of Pittsburgh.
The research was supported by the National Institute of Mental Health of the National Institutes of Health award K08MH123624; the Agency for Healthcare Research and Quality award T32HS00029; and the National Institute on Drug Abuse of the NIH award K01DA051761. The content is the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ.
JOURNAL
Health Affairs
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Psychiatrist Networks In Medicare Advantage Plans Are Substantially Narrower Than In Medicaid And ACA Markets
ARTICLE PUBLICATION DATE
5-Jul-2023
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