Variation in Breast Cancer Care among Medicaid Fee for Service and Health Maintenance Organization Enrollees

Objective: To analyze if breast cancer (BCa) care among female Medicaid recipients with and without serious mental illness (SMI) varies across plan: Fee for Service (FFS) vs. Health Maintenance Organization (HMO). Methods: Female Medicaid BCa patients aged 18-64 and enrolled in a FFS or HMO plan were identified using Pennsylvania Medicaid Claims between 1995 and 2004. From this cohort, we identified those with a diagnosis of SMI. BCa with SMI group and BCa only group were retrospectively followed for one year pre and up to two years post the date of first claim for BCa. Demographic and clinical attributes, screening and health resource utilization (HRU) patterns were compared across the two cohorts. To access the incremental burden of SMI, we used GLM log-link models. Cox proportional hazard model was used to study the effect of SMI on survival. Results: Our cohort consisted of 5926 BCa patients enrolled in a FFS plan and 4940 enrolled in a HMO. Proportion of BCa patients with SMI was lower in FFS group, compared to HMO group (7.9 vs. 17.6, p<.0001). BCa with SMI group had higher HRU and cost, compared to the BCa only group, for FFS and HMO enrollees. GLM log-link model indicated that the incremental burden of cost due to SMI was higher for HMO enrollees, compared to FFS enrollees (beta 0.17 vs. 0.25), after adjusting for covariates. Conclusions: There exists significant variation in HRU and cost of BCa care across FFS and HMO. This demands further studies to understand the factors associated with these variations.