Skip to main content

Advertisement

SpringerLink
Log in

Care experiences among dually enrolled older adults with cancer: SEER-CAHPS, 2005–2013

  • Original Paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

Given the associations between poverty and poorer outcomes among older adults with cancer, we sought to understand the effects of dual enrollment in Medicare and Medicaid—as a marker of poverty—on self-reported care experiences among seniors diagnosed with cancer.

Methods

Retrospective, observational study using cancer registry, Medicare claims, and care experience survey data (Surveillance, Epidemiology, and End Results [SEER]—Consumer Assessment of Healthcare Providers and Systems [CAHPS®]) for a national sample of fee-for-service (FFS) and Medicare Advantage (MA) enrollees aged 65 or older. We included people with one incident primary, malignant cancer diagnosed between 2005 and 2011, surveyed within 2 years after diagnosis (n = 9,800; 995 dual enrollees). Medicare CAHPS measures included 5 global ratings and 3 composite scores.

Results

After adjustment for potential confounders, people with cancer histories who were dually enrolled were significantly more likely to report better experiences than non-duals on 2 measures (Medicare/their health plan: adjusted odds ratio [aOR]: 0.68, 95% confidence interval [CI] 0.53–0.87; prescription drug plan [PDP]: aOR: 0.54, 95% CI 0.40–0.73).

Conclusions

Dual enrollees with cancer reported better experiences than Medicare-only enrollees in terms of their health plan (Medicare FFS or Medicare Advantage) and their PDP. Better ratings among dually enrolled beneficiaries suggest possible divergence between health outcomes and care experiences, warranting additional investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marmot MG, Bell R (2009) Action on health disparities in the United States: commission on social determinants of health. JAMA 301:1169–1171

    Article  CAS  PubMed  Google Scholar 

  2. Andrulis DP (1998) Access to care is the center piece in the elimination of socioeconomic disparities in health. Ann Internal Med 129:412–416

    Article  CAS  Google Scholar 

  3. Siminoff LA, Ross L (2005) Access and equity to cancer care in the USA: a review and assessment. Postgrad Med J 81:674–679

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Koroukian SM, Xu F, Dor A, Cooper GS (2006) Colorectal cancer screening in the elderly population: disparities by dual Medicare-Medicaid enrollment status. Health Serv Res 41:2136–2154

    Article  PubMed  PubMed Central  Google Scholar 

  5. Boscoe FP, Henry KA, Sherman RL, Johnson CJ (2016) The relationship between cancer incidence, stage and poverty in the United States. Int J Cancer 139:607–612

    Article  CAS  PubMed  Google Scholar 

  6. Bradley CJ, Dahman B, Given CW (2008) Treatment and survival differences in older Medicare patients with lung cancer as compared with those who are dually eligible for Medicare and Medicaid. J Clin Oncol 26:5067–5073

    Article  PubMed  PubMed Central  Google Scholar 

  7. Carcaise-Edinboro P, Bradley CJ, Dahman B (2010) Surveillance mammography for Medicaid/Medicare breast cancer patients. J Cancer Surviv 4:59–66

    Article  PubMed  Google Scholar 

  8. Doll KM, Meng K, Basch EM, Gehrig PA, Brewster WR, Meyer AM (2015) Gynecologic cancer outcomes in the elderly poor: a population-based study. Cancer 121:3591–3599

    Article  PubMed  Google Scholar 

  9. Kirby J, Berdahl T (2012) Indicators of health care quality by income and insurance status among individuals with a usual source of care, 2009. https://meps.ahrq.gov/mepsweb/data_files/publications/st367/stat367.shtml. Accessed 24 Mar 2014.

  10. Ahmed S, Shahid RK (2012) Disparity in cancer care: a Canadian perspective. Curr Oncol 19:e376–e382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. National Cancer Institute (2017) Health disparities. https://cancercontrol.cancer.gov/research-emphasis/health-disparities.html. Accessed 7 Feb 2018.

  12. Kaiser Family Foundation (2015) State health facts: Medicare dual eligibles. Kaiser Family Foundation, San Franciso, CA

    Google Scholar 

  13. MedPAC. Dual eligible beneficiaries: an overview. Report to the congress: New approaches in Medicare, Chapter 3, pp 71–94

  14. Stefanacci RG (2011) Improving the care of “dual eligibles”— what’s ahead. Ann Long Term Care Clinic Care Aging 19(9):26–30

    Google Scholar 

  15. MedPAC. (2016) Data book: beneficiaries dually eligible for Medicare and Medicaid. https://medpac.gov/docs/default-source/publications/january-2016-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-Medicare-and-Medicaid.pdf?sfvrsn=0. Accessed 20 Jun 2019.

  16. Berwick DM, Nolan TW, Whittington J (2008) The triple aim: care, health, and cost. Health Aff 27:759–769

    Article  Google Scholar 

  17. Mollica MA, Lines LM, Halpern MT et al (2017) Patient experiences of cancer care: scoping review, future directions, and introduction of a new data resource: surveillance epidemiology and end results-consumer assessment of healthcare providers and systems (SEER-CAHPS). Patient Exp J 4:103–121

    Article  Google Scholar 

  18. Chawla N, Urato M, Ambs A et al (2015) Unveiling Seer-Cahps®: a new data resource for quality of care research. J Gen Intern Med 30:641–650

    Article  PubMed  PubMed Central  Google Scholar 

  19. Halpern MT, Urato MP, Kent EE (2017) The health care experience of patients with cancer during the last year of life: analysis of the SEER-CAHPS data set. Cancer 123:336–344

    Article  PubMed  Google Scholar 

  20. National Cancer Institute (2016) SEER-Medicare publications by journal & year. National Cancer Institute, Bethesda, MA

    Google Scholar 

  21. Elliott MN, Haviland AM, Orr N, Hambarsoomian K, Cleary PD (2011) How do the experiences of Medicare beneficiary subgroups differ between managed care and original Medicare? Health Serv Res 46:1039–1058

    Article  PubMed  PubMed Central  Google Scholar 

  22. National Cancer Institute (2017) Medicare CAHPS response rates. National Cancer Institute, Bethesda, MA

    Google Scholar 

  23. Martino SC, Elliott MN, Cleary PD et al (2009) Psychometric properties of an instrument to assess Medicare beneficiaries' prescription drug plan experiences. Health Care Financ Rev 30:41–53

    PubMed  PubMed Central  Google Scholar 

  24. National Cancer Institute (2017) SEER-CAHPS data documentation. National Cancer Institute, Bethesda, MA

    Google Scholar 

  25. Damiano PC, Elliott M, Tyler MC, Hays RD (2004) Differential use of the CAHPS® 0–10 global rating scale by Medicaid and commercial populations. Health Serv Outcomes Res Methodol 5:193–205

    Article  Google Scholar 

  26. Halpern MT, Urato MP, Kent EE (2016) The health care experience of patients with cancer during the last year of life: analysis of the SEER-CAHPS data set. Cancer 123:336–344

    Article  PubMed  Google Scholar 

  27. Hargraves JL, Hays RD, Cleary PD (2003) Psychometric properties of the consumer assessment of health plans study (CAHPS) 2.0 adult core survey. Health Serv Res 38:1509–1527

    Article  PubMed  Google Scholar 

  28. Macias C, Gold PB, Öngür D, Cohen BM, Panch T (2015) Are single-item global ratings useful for assessing health status? J Clin Psychol Med Settings 22:251–264

    Article  Google Scholar 

  29. Ware J, Kosinski M, Gandek B (2003) SF-36 health survey: manual & interpretation guide. Quality Metric Inc, Lincoln, RI

    Google Scholar 

  30. Zaborski LB, Zaslavsky AM (2012) MCAHPS Technical Report, appendix 2.04: individual-level weight construction. RAND, Santa Monica, CA

    Google Scholar 

  31. Warren JL, Butler EN, Stevens J et al (2015) Receipt of chemotherapy among Medicare patients with cancer by type of supplemental insurance. J Clin Oncol 33:312–318

    Article  PubMed  Google Scholar 

  32. Elliott MN, Haviland AM, Kanouse DE, Hambarsoomian K, Hays RD (2009) Adjusting for subgroup differences in extreme response tendency in ratings of health care: impact on disparity estimates. Health Serv Res 44:542–561

    Article  PubMed  PubMed Central  Google Scholar 

  33. Allen SM, Piette ER, Mor V (2014) The adverse consequences of unmet need among older persons living in the community: dual-eligible versus Medicare-only beneficiaries. J Gerontol B 69(Suppl 1):S51–S58

    Article  Google Scholar 

  34. Priest J, Buikema A, Engel-Nitz NM, Cook CL, Cantrell CR (2012) Quality of care, health care costs, and utilization among Medicare part D enrollees with and without low-income subsidy. Popul Health Manag 15:101–112

    Article  PubMed  Google Scholar 

  35. Rahman M, Grabowski DC, Gozalo PL, Thomas KS, Mor V (2014) Are dual eligibles admitted to poorer quality skilled nursing facilities? Health Serv Res 49:798–817

    Article  CAS  PubMed  Google Scholar 

  36. Koroukian SM, Bakaki PM, Owusu C, Earle CC, Cooper GS (2012) Cancer outcomes in low-income elders: is there an advantage to being on Medicaid? Medicare Medicaid Res Rev 2:2

    Google Scholar 

  37. Elliott M, Swartz R, Adams J, Spritzer K, Hays R (2001) Consumer evaluations of health plans and health care providers. Case-mix adjustment of the national CAHPS benchmarking data 10: a violation of model assumptions? Health Serv Res 36:555–574

    CAS  PubMed  PubMed Central  Google Scholar 

  38. O'Malley AJ, Zaslavsky AM, Elliott MN, Zaborski L, Cleary PD (2005) Case-mix adjustment of the CAHPS® hospital survey. Health Serv Res 40:2162–2181

    Article  PubMed  PubMed Central  Google Scholar 

  39. Potetz L, DeWilde LF (2009) Cancer and Medicare: a chartbook. American Cancer Society Cancer Action Network, Washington, DC

    Google Scholar 

  40. Elliott MN, Beckett MK, Chong K, Hambarsoomians K, Hays RD (2008) How do proxy responses and proxy-assisted responses differ from what Medicare beneficiaries might have reported about their health care? Health Serv Res 43:833–848

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Funding for this research was provided to LML, JC, and MTH under National Cancer Institute Contract #HHSN-261–2015-00132U.

Author information

Authors and Affiliations

  1. RTI International, 307 Waverley Oaks Rd, Suite 101, Waltham, MA, 02452, USA

    Lisa M. Lines & Julia Cohen

  2. University of Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA, 01655, USA

    Lisa M. Lines

  3. Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA

    Michael T. Halpern & Ashley Wilder Smith

  4. Gillings School of Public Health, University of North Carolina - Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27559, USA

    Erin E. Kent

Authors
  1. Lisa M. Lines
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael T. Halpern
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley Wilder Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erin E. Kent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa M. Lines.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Dr. Halpern was employed by RTI International and Temple University at the time of this study’s initial submission. He is now employed by the National Cancer Institute. At the time of initial submission, Dr. Kent was affiliated with the National Cancer Institute.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 160 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lines, L.M., Cohen, J., Halpern, M.T. et al. Care experiences among dually enrolled older adults with cancer: SEER-CAHPS, 2005–2013. Cancer Causes Control 30, 1137–1144 (2019). https://doi.org/10.1007/s10552-019-01218-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-019-01218-7

Keywords

Search

Navigation