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February 1, 2024

Navigating the 'Medicare Effect': Preparing for Increased Cancer Screenings in Medicare Advantage Plans

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What is the Medicare Effect?

As individuals become eligible for Medicare, there is a noticeable increase in cancer screenings

and diagnoses—particularly for lung, breast, prostate, and colorectal cancers—during the first year of Medicare coverage. This shift ​is commonly known as the 'Medicare effect,' and highlights a critical period when Medicare Advantage (MA) plans need to be ready with improved screenings and care for new members. We'll look at this increase in detail and how MA plans can strategically adapt to support these individuals right from the start.

Understanding the Medicare Effect


As stated above, upon reaching Medicare eligibility, a person's likelihood of undergoing cancer screenings significantly increases. For example, lung cancer rates double for those aged 65​, and colon cancer screenings jump to nearly 15%​. Similarly, breast cancer screenings rise by 50% in the first year of Medicare coverage​​. This initial period is clearly a critical window for detection and subsequent intervention.

Medicare Advantage Cancer Coverage

MA plans can play a significant role in meeting the needs of these newly diagnosed members. Not only do these plans provide a wide range of cancer screenings, but they also provide preventive care, which is essential for early detection and treatment. Research has shown that MA beneficiaries, especially those with a history of cancer, are likely to spend less out-of-pocket and are more likely to receive preventive services​​ once they’re on a MA plan. This is particularly crucial for cancer patients, who may face significant healthcare costs.

Strategies for Medicare Advantage Plans


One of the key strategies for MA plans is to focus on care coordination and navigation for cancer patients. After a cancer diagnosis, patients often have to deal with the complex task of seeing different healthcare providers and figuring out their services. MA plans can really help out here. MA plans, with their ability to coordinate care and provide a network of providers, can facilitate the process for patients, ensuring they receive the right treatment early on​​.

Expanding provider networks to include cancer expertise is another strategic approach for MA plans. This can involve offering remote access to subspecialists from National Cancer Institute-Comprehensive Cancer Centers. Such access can be vital in providing high-quality care and improving outcomes for cancer patients, as MA plans can leverage innovations like holistic palliative care models, supplemental benefits, and risk stratification models to provide whole-person care​​.

The research and findings from sources like the Better Medicare Alliance and ATI Advisory indicate that MA plans are well-positioned to support cancer patients and survivors through tailored benefits and innovative care approaches​​. This demonstrates the importance of proactive identification and the strategic expansion of provider networks to include specialized cancer care, which could significantly impact the quality of care and outcomes for patients diagnosed with cancer under MA plans.

The Downside to Medicare Advantage Plans

Despite the benefits of MA plans, a study published in the Journal of Clinical Oncology suggests there are downsides for those with complex cancer needs, particularly when plans have limited provider options.​​ This is where AccessHope steps in. With services like Accountable Precision Oncology (APO) and Expert Advisory Review (EAR), AccessHope aims to bridge these gaps. They connect members with top cancer specialists, enhancing the care MA plans can provide for serious cases.

Embracing the Future of Medicare Advantage Plans

In conclusion, the 'Medicare effect' signifies a time of both challenge and opportunity for MA plans. By enhancing cancer screenings and integrating services like those offered by AccessHope, these plans can not only meet but exceed the expectations of their members. The journey from early detection to comprehensive care is critical, and with the right strategies in place, MA plans can ensure that this journey leads to better health outcomes. 

Health plan providers should consider these insights and take the next step by exploring AccessHope's dedicated services, designed to fortify cancer care for those who need it most.

For an in-depth understanding of how AccessHope enriches health plans with expert cancer support services, visit the AccessHope Health Plans page.

The Pathway to AccessHope’s Health Plans



Understanding the challenges and opportunities within the Medicare Advantage landscape is crucial for health plans aiming to provide optimal cancer care. For a closer look at how AccessHope supports health plans in delivering expert cancer care, including for those with complex needs, visit the AccessHope Health Plans page.

 

References
 
1  Joszt, Laura. AJMC. Increases in Cancer Screenings, Chronic Condition Diagnoses in First Year of Medicare Coverage. https://www.ajmc.com/view/increases-in-cancer-screenings-chronic-condition-diagnoses-in-first-year-of-medicare-coverage. Published August 11, 2023. Accessed November 13, 2023.
 
2  White, Tracie. Stanford Medicine. Jump in cancer diagnoses at 65 implies patients wait for Medicare, according to Stanford study. https://med.stanford.edu/news/all-news/2021/03/Cancer-diagnoses-implies-patients-wait-for-Medicare.html#:~:text=Lung%20cancer%20rates%20showed%20a,at%2065. Published March 30, 2021. Accessed November 13, 2023.
 
3  Trusdell, Megan. Patient Power. Study Implies Many Delay Cancer Screenings Until Eligible for Medicare. https://www.patientpower.info/navigating-cancer/financial-and-insurance/study-implies-many-delay-cancer-screenings-until-eligible-for-medicare. Updated April 14, 2021. Accessed November 13, 2023.
 
4 Joszt, Laura. AJMC. Increases in Cancer Screenings, Chronic Condition Diagnoses in First Year of Medicare Coverage. https://www.ajmc.com/view/increases-in-cancer-screenings-chronic-condition-diagnoses-in-first-year-of-medicare-coverage. Published August 11, 2023. Accessed November 13, 2023.
 
5 Better Medicare Alliance. (n.d.). Study: Medicare Advantage has unique ability to meet needs of cancer patients and survivors. Better Medicare Alliance. Accessed November 13 2023. https://bettermedicarealliance.org/news/study-medicare-advantage-has-unique-ability-to-meet-needs-of-cancer-patients-and-survivors/
 
6 Ibid
 
7 Ibid
 
8 Ibid
 
9 Raoof, M., Ituarte, P. H. G., Haye, S., Jacobson, G., Sullivan, K. M., Eng, O., Kim, J., & Fong, Y. (n.d.). Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients. Journal of Clinical Oncology. Accessed November 13, 2023. https://ascopubs.org/doi/10.1200/JCO.21.01359
 
 

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