Utilization of breast cancer screening among Medicare Advantage enrollees

Background:Breast cancer screening (BCS) improves early detection of breast cancer in women. Interventions have been conducted to enhance BCS rate. However the rate reported by CMS for the Medicare Advantage (MA) population is still below the Healthy People recommended screening rate of 81% by 2020. This study identifies characteristics of beneficiaries who underutilize BCS, therefore providing evidence about which subpopulations should be targeted for interventions to improve outcomes.

Methods: The study sampled MA beneficiaries from a large nationally representative administrative claims database. The BCS rate was calculated using 2014 HEDIS specifications. A splined logistic regression model was used to assess the association between BCS and member characteristics.

Results: The study population included 365,407 women aged 50-74 years (Mean ± SD: 68.9±4.5). Of these, 69.3% had a BCS. The slope of linear association between age and BCS changed at age 65 (x²=361.19, p<0.0001). This reversed U-shaped effect of age on BCS showed no difference for 50-55 versus 70-74 age groups (OR=1.01, 95% CI: 0.94-1.09). Physically disabled women were less likely to utilize BCS than those without disability (OR=0.71, 95% CI: 0.69-0.73). Women with no comorbidities were less likely to get BCS versus those with one or more comorbidities (OR=0.79, 95% CI: 0.77-0.80). Institutionalized residents were also less likely to have BCS than non-institutionalized residents (OR=0.13, 95% CI: 0.08-0.19). 

Conclusions: Strategic efforts initiated by health plans can focus on members with identified characteristics to efficiently increase BCS rates and improve health plan performance on this quality metric.