April 14, 2016 – Over 42,000 of low-income adults in Minnesota weren’t screened for colorectal cancer in 2015, according to the ninth annual Health Care Disparities Report conducted by MN Community Measurement (MNCM) and sponsored by the Minnesota Department of Human Services (DHS). In both men and women, colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in the United States.
The disparity in colorectal cancer screening rates between Medicaid patients and all other patients continues to be the largest gap in care identified in the report. Only 53.9 percent of Medicaid-covered adults ages 50 to 75 were screened for colon cancer in 2015, compared to 74.3 percent of those covered by other types of insurance.
“The time has come for the health care community and the state as a whole to address these persistent disparities in health care,” said Human Services Commissioner Emily Piper. “It’s unacceptable that the people we serve in public health care programs don’t always get the same level of screening for extremely serious health care issues such as colon and breast cancer
While the overall rate of colon cancer screenings has increased in recent years, the gap in care for lower-income Minnesotans has persistently remained at 20 percent since 2012. In fact, this is the seventh year in a row that colorectal cancer screenings have had the largest disparity among the 12 measures tracked by the report. During 2015, that meant more than 18,664 fewer Medicaid patients were screened than their counterparts.
According to the American Cancer Society, screening for colon cancer can reduce the death rates both by preventing the disease and by detecting it at earlier at more treatable stages. The relative five-year survival rate is 90 percent for patients diagnosed at an early, localized stage; however, only 40 percent of cases are diagnosed with this stage.
Breast cancer screenings
The report also identified a moderate 1.2 percent decrease in breast cancer screenings amongst Medicaid-covered women ages 50 to 74. During 2015, only 61.5 percent of patients covered by Medicaid received the screening compared to 76.8 percent of patients covered by other insurance types. The gap in breast cancer screenings, increased from 14.3 percent in 2014 to 15.3 percent in 2015. During 2015, that meant more than 3,237 fewer Medicaid patients were screened than their counterparts.
Breast cancer is the most commonly diagnosed cancer is women and the second leading cause of cancer death among women. However, death rates have been declining for the last 25 years in part due to better screening and early detection, increased awareness, and continually improving treatment options, according to the National Breast Cancer Foundation, Inc.
Additional report findings
More work remains to be done to close gaps in care between people covered by Medicaid and those who have commercial insurance. Ten of the 12 measures tracked showed significantly lower outcomes for patients covered by state programs. In addition to colorectal and breast cancer screenings, the other largest gap persists in Optimal Asthma Control for patients ages 18 to 50.
Other notable results include:
- The highest rate reported was for Appropriate Treatment for Children with Upper Respiratory Infections (URI), where 92 percent of MHCP patients received the recommended care. This rate was 3.2 percent higher than that for non-MHCP patients. This means more MHCP-covered children are not dispensed an antibiotic when given a diagnosis of URI.
- The lowest rate of optimal care reported was for Depression at Six Months. Only 5.5 percent of MHCP patients achieved remission of their depression symptoms six months after being diagnosed, compared to 9.9 percent of non-MHCP patients.
- The statewide gap in performance rates between MHCP and Other Purchasers has narrowed over the last seven years for Chlamydia Screening in Women. In 2015, the MHCP statewide rate for chlamydia screening was 56 percent; the rate for Other Purchasers was 47 percent.
- The MHCP rate for Childhood Immunization Status (Combo 3) continues to decrease, a concerning trend that highlights substantial room for improvement.
- The Appropriate Testing for Children with Pharyngitis (sore throat) measures shifted from a decrease in MHCP rates last year to a significant increase this year.
The report also evaluates differences in care by race and ethnicity within the population covered by Medicaid programs. Noteworthy findings include:
- Blacks/African-Americans continue to have the highest rate of chlamydia screening, while Whites have the lowest and a significantly lower rate than the average for patients in government health care programs.
- American Indians and Alaskan Natives continue to have the lowest rate of breast cancer screenings, while Whites have the highest and a significantly higher rate than the average for patients in state programs.
- American Indians continue to have the lowest rate of childhood immunizations, and along with Blacks/African Americans, have a significantly lower rate that the average for patients in state public programs. This measure looks at whether children have received all of the recommended vaccinations by age 2.
“There is considerable and critical work to be done to eliminate health care disparities in Minnesota,” said MNCM President Jim Chase. “Providers need to use this type of information for improvement in their practices and to find ways to give their patients better care.”
More than one million Minnesotans receive health care coverage through Medicaid health care programs overseen by the Department of Human Services.
The Health Care Disparities Report highlights performance rates for patients in the managed care component of Medicaid programs, including Medical Assistance and MinnesotaCare. Since Minnesotans eligible for these programs have lower-than-average incomes, comparing this group of patients to commercially-insured patients is a strong way to illustrate Minnesota’s socioeconomic health care disparities.
DHS sponsors the creation of the Health Care Disparities Report by MNCM as part of its mutual commitment to making health care disparities data public. Sharing this information helps providers and care systems recognize the gaps and take steps to close them.
The 2015 Health Care Disparities Report, as well as all previous versions, is available at https://mncm.org/health-care-disparities-report/.
MN Community Measurement is an independent, non-profit organization dedicated to improving health by publicly reporting health care information. As the primary trusted source of health care measurement, data sharing and public reporting for more than a decade, MNCM works with health plans, providers, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value. Learn more at www.mncm.org.