Colorectal (CRC) and breast cancer (BC) are leading causes of cancer death in the United States. CRC and BC disproportionately affect older adults. Early detection of these cancers greatly improves survival rates, yet, in 2010, more than half of adults aged 65 and older were not up to date on recommended preventive care services, including cancer screening. As part of the Affordable Care Act, Medicare undertook multiple policy changes in 2011 to encourage utilization of evidence-based preventive care, including: (1) eliminating cost sharing for all preventive care services with an A or B rating by the US Preventive Services Task Force; (2) introducing a new annual check-up, the Annual Wellness Visit (AWV), with no cost sharing; and (3) providing a bonus payment to primary care providers (PCPs) serving health care shortage areas. Although these policy changes have been in effect for most of the last decade, there is limited evidence of their effectiveness to increase cancer screening in older adults, detect more early-stage cancer cases, and reduce mortality from CRC and BC. Additionally, utilization patterns suggest there are physician and patient factors driving use of the AWV. However, the role of provider factors and patient self-selection on AWV utilization is unknown. The proposed mixed-methods study seeks to understand how, and to what extent, the 2011 Medicare policy changes have affected the burden of CRC and BC among Medicare beneficiaries.
The specific aims of the study are to: 1) qualitatively explore PCP perceptions of rationale for conducting AWVs, AWV value, and factors influencing beneficiary self-selection to utilize the AWV; 2) estimate the effect of the global 2011 Medicare policy changes on CRC and BC outcomes and 3) estimate the effect of beneficiary-level utilization of the AWV on CRC and BC outcomes. Using a convergent mixed-methods approach, qualitative data will help to understand processes and provide detailed information about the context in which AWVs are being delivered. At the point of interpretation, qualitative and quantitative findings will be compared to assess convergence, divergence, or contradiction in the findings. This study has been designed to provide the applicant with experience necessary to continue along the pathway to becoming an independent investigator with expertise in primary health care access, vulnerable aging adults, and mixed-methods research designs. The proposal is aligned with two of AHRQ?s research priority areas, elderly patients and access to care.
As part of the Affordable Care Act, Medicare undertook multiple policy changes in 2011 to address underutilization of evidence-based preventive and cancer screening services among the elderly. The proposed mixed-methods study aims to understand how and to what extent the 2011 Medicare policy changes, including introduction of the Medicare Annual Wellness visit, have reduced the burden of colorectal and breast cancers among Medicare beneficiaries. In addition, it will lend understanding of the underlying motivation for providers to deliver the Annual Wellness Visit, and their perceptions of the role of patient self-selection on Annual Wellness Visit utilization.
