How Does Managed Care Improve the Quality of Breast Cancer Care Among Medicare-Insured Minority Women?
The aim of this study is to investigate if evidence-based clinical guidelines are implemented equitability among ethnic minority breast cancer patients using Medicare Advantage and investigate if presumed advantages of managed care over fee-for-service are greater for minorities than for Whites.



Data from the Surveillance, Epidemiology, and End Results and Medicare were used to examine 70,755 women over age 65 diagnosed with early stage breast cancer between 2005 and 2009. Implementation of two clinical guidelines was assessed: receipt of radiation therapy after breast conserving surgery and estrogen receptor status documentation. Multilevel logistic regression and inverse propensity weighting controlled for confounding.



African Americans are still less likely than Whites to receive radiation therapy after breast-conserving surgery, whether they use Medicare fee-for-service (OR 95 % CI) = 0.90 (0.83, 0.98) or managed care (OR 95 % CI) = 0.87 (0.76, 1.00). Differences between receipt of radiation therapy by insurance plan type was nonexistent. Relative to FFS, the use of managed care improved the odds of having estrogen receptor status documented by 44 % in African Americans, (OR 95 % CI) = 1.44 (1.15, 1.83) and by 42 % in Latina patients (OR 95 % CI) = 1.42 (1.17, 1.78).



Compared to Medicare fee-for-service, ethnic and racial disparities among Medicare Advantage users were reduced. We observed fewer disparities, but not an elimination of disparities, among Medicare Advantage enrollees receiving breast cancer care with an organizational and patient component of care. This suggests managed care may still need to focus on minority patient empowerment and involvement in care.
School of Community Health Sciences, University of Nevada, 1664 North Virginia Street/MS 274, Reno, NV, 89557, USA. jsmithgagen@unr.edu.
Julie
0000-0001-9796-3409
J
Smith-Gagen
College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA.
Travis
T
Loux
Division of Statistics, University of California, Davis, CA, USA.
Chris
C
Drake
Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA.|National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
Eliseo J
EJ
Pérez-Stable
D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008329:Managed Care Programs; D006278:Medicare; D008913:Minority Groups; D011787:Quality of Health Care; D014481:United States; D044465:White People
Breast cancer; Disparities; Medicare managed care