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Medicaid patients received fewer colon, cervical cancer screenings in 2013

Seventh annual report shows gaps in care persist for key health screenings
Almost half of low-income adults in Minnesota weren’t screened for colorectal cancer in 2013, according to the seventh annual Health Care Disparities Report conducted by MN Community Measurement and sponsored by the Minnesota Department of Human Services. Colon cancer is the third leading cause of cancer-related deaths 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 51.8% of Medicaid-covered adults ages 50 to 75 were screened for colon cancer in 2013, compared to 71.8% of those covered by other types of insurance.

“Colon cancer is not only treatable and beatable, it is preventable,” said the American Cancer Society’s Matt Flory. “We are concerned that fewer Minnesotans insured by state public programs are getting simple tests that could stop cancer before it starts.”

This is the third year in a row that colorectal cancer screenings have had the largest disparity among the 13 measures tracked by the report.

Colon cancer rates nationally have dropped 30% during the past decade, largely due to an increase in screenings, according to Flory. Screenings can identify and remove polyps before they become cancerous, reducing the overall rate of cancer and associated deaths. “Lower rates of colon cancer screening could translate into higher rates of colon cancer,” he said.

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% since 2010. During 2013, that meant more than 10,700 fewer Medicaid patients were screened than their counterparts.

Cervical cancer screenings
The report also identified a large decrease in cervical cancer screenings amongst Medicaid-covered women ages 24 to 64. The 7.5% drop in screenings resulted in the largest disparity for that measure since 2005. During 2013, only 61.6% of patients covered by Medicaid received the screening compared to 74.2% of patients covered by other insurance types.

Despite this, cervical cancer screenings is an area where Minnesota has had the most success eliminating disparities. The number of women on Medicaid being screened has increased 26 percentage points since 2004, from 42.8% to 61.6%. This is the largest improvement over time of all measures evaluated.

Like colon cancer, most cervical cancers begin with non-cancerous cells that can be treated and/or removed before they develop into cancer. Treating pre-cancerous cells can prevent almost all cervical cancers, according to the American Cancer Society.

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. Eleven of the 13 measures tracked showed significantly lower outcomes for patients covered by state programs. In addition to colorectal cancer screening, the largest gaps persist in optimal diabetes care, optimal vascular care and optimal asthma care for patients ages 18 to 50.

The report analyzes whether Medicaid patients are receiving better care over time. Seven of 13 measures improved for Medicaid patients from 2012 to 2013. For the 12 measures that have been tracked for three or more years, 11 have shown improvement over time.

It also evaluates differences in care by race and ethnicity within the population covered by Medicaid programs. Notable findings include:

  • Blacks/African-Americans have a significantly lower rate for controlling blood pressure than the average for patients in state programs.
  • Blacks/African-Americans have the highest rate of chlamydia screening, while Whites have the lowest and a significantly lower rate than the average for patients in state programs.
  • American Indians continue to have the lowest rate of childhood immunizations, which looks at whether children have received all of the recommended vaccinations by age 2.

“People in public programs, especially those of color or with language barriers, have worse results from their health care than the general public,” said Jim Chase, president of Minnesota Community Measurement. “The recent expansion in the number of Minnesotans on public programs makes these disparities even more important to address now.”

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 publishes performance rates for patients in the managed care component of Medicaid programs, including Medical Assistance and MinnesotaCare. Because people who are poor, people with disabilities and people of color are over-represented in those programs, comparing Medicaid patients to commercial patients illustrates Minnesota’s health care disparities.

The Department of Human Services sponsors the report by MN Community Measurement as part of their 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.

“We’re focused on showing where medical groups have improved results for these patients, and using that information to encourage other groups to make progress as well,” Chase said.

View the full 2013 Health Care Disparities Report (PDF).

About MN Community Measurement
MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care quality measurement and public reporting since 2003, MNCM works with health plans, providers, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value.