Mammography rates vary among Medicare Advantage plans, indicating need for transparency

A review of mammography screening rates in Medicare Advantage (MA) plans found for-profit providers lagging behind their non-profit colleagues, signaling the importance of publicizing performance data so consumers and regulators can make informed decisions. The nearly 6 percent gulf may reflect culture differences between non-profit and for-profit providers, according to a study published in the Journal of the American College of Radiology.

The number of Americans covered under Medicare has more than doubled since the 1960s, numbering 56 million people by 2015—17 percent of the U.S. population. MA has grown even more quickly than that, with enrollees swelling from 5.3 million in 2004 to 17.6 million in 2016. Past studies have shown MA plans carry higher rates of preventative service utilization, including screening mammography, annual flu vaccinations and cholesterol testing.

Researchers aggregated data from the 2016 Medicare Advantage Effectiveness Data and Information Set Public Use File, identifying screening mammography rates for all 385 MA plans nationwide.

Screening rates were overall high, but there was a significant gap between non-profit providers and for-profit providers—77.3 percent versus 71.8 percent, respectively. Other statistically significant correlations included the length of contract, total plan enrollment, and percentage of non-Hispanic whites enrolled.

“Achieving high mammography utilization rates takes a lot of effort,” said lead author and Andrew Rosenkrantz, MD, associate professor at the New York University School of Medicine, in an interview with Radiology Business. “Some plans are more successful in care coordination and investment of resources—it could relate to differences in leaderships’ priorities and goals.”

While the study didn’t pinpoint exact reasons for the divide on tax status, it highlights how increased transparency has benefits for both patients and regulators, according to Rosenkrantz.

“It’s about letting patients make informed choices, the transparency might encourage the plans to take the necessary actions to get their performance as high as possible,” he said. “Patients can use this data if they are picking plans, and those that make policy that influences the MA program can use this information to help shape policy efforts.”

This push towards transparency is part of a larger movement in U.S. healthcare. While significant barriers to development and patient utilization of transparency tools still remain, the industry has started on an inexorable march towards clarity, according to Rosenkrantz.

“Everything is moving in this direction. Transparency tools are increasing in number and robustness, they’re’ giving more info and they’re more patient friendly,” said Rosenkrantz. “We’re seeing it all throughout radiology and medicine as a whole. It’s embraced by MACRA, private payers and policy makers—all of whom are embracing value-based payment models.”

With the Trump administration indicating a desire to expand the MA program, ensuring patient access to quality data is an important step toward informed choices and a healthier population, according to the study. 

Other contributing authors include Richard Duszak, JR., MD, and Margaret M. Fleming, MD, both from Emory University School of Medicine.