# Cancer detection and care for dually-enrolled beneficiaries in the Medicare Shared Savings Program

> **NIH AHRQ R36** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2021 · $20,893

## Abstract

PROJECT SUMMARY/ABSTRACT
Individuals dually enrolled in Medicare and Medicaid (“duals”) are a socially and clinically vulnerable population
who account for a disproportionate amount of healthcare expenditures paid by both programs. Duals have a
higher burden of disease compared to Medicare only beneficiaries, with more than 20% of individuals having
multiple chronic conditions. Duals also have worse cancer outcomes. They are less likely to receive
recommended screening, are less likely to receive definitive treatment after a cancer diagnosis, and have a
higher risk of cancer-specific mortality. The complex social and healthcare needs of duals present a challenge
in effectively delivering high quality cancer care to these patients.
Accountable care organizations (ACOs) strive to provide coordinated, high-quality care to patients while
containing costs for payers. As Medicare’s predominant ACO model, the Medicare Shared Savings Program
(MSSP) has shown promise in improving quality of care, generating savings per beneficiary, and caring for
clinically vulnerable patients. Whether the MSSP increases the quality of care across the cancer continuum for
duals remains relatively unknown.
The proposed study investigates how much the MSSP ACO model improves quality of cancer care for a clinically
complex, vulnerable patient population. Studies will compare cancer outcomes for MSSP-attributed duals to
duals who did not receive care from the MSSP ACO. Aim 1 will estimate the effect of MSSP ACOs on breast
and colorectal cancer screening of duals using a quasi-experimental difference-in-difference analysis. Aim 2 will
employ a time-to-event survival analysis to compare the time to treatment initiation after a breast or colorectal
cancer diagnosis. Using generalized estimating equations, Aim 3 will assess differences in total Medicare
spending in the first year of cancer treatment for duals with breast and colorectal cancer. Taken together, the
results of this proposed study will inform policymakers and providers on whether value-based care reforms
deliver better quality of care in screening and treatment of breast and colorectal cancer for dually enrolled
beneficiaries.

## Key facts

- **NIH application ID:** 10294818
- **Project number:** 1R36HS028536-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Nul L Oh
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $20,893
- **Award type:** 1
- **Project period:** 2021-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10294818

## Citation

> US National Institutes of Health, RePORTER application 10294818, Cancer detection and care for dually-enrolled beneficiaries in the Medicare Shared Savings Program (1R36HS028536-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10294818. Licensed CC0.

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