# The Effects of Expanding Medicare Prevention Coverage on Colorectal and Breast Cancer Burden: A Mixed Methods Study

> **NIH AHRQ R36** · UNIVERSITY OF COLORADO DENVER · 2020 · $43,046

## Abstract

PROJECT SUMMARY
Colorectal (CRC) and breast cancer (BC) are leading causes of cancer death in the United States. CRC and
BC disproportionately affect older adults. Early detection of these cancers greatly improves survival rates, yet,
in 2010, more than half of adults aged 65 and older were not up to date on recommended preventive care
services, including cancer screening. As part of the Affordable Care Act, Medicare undertook multiple policy
changes in 2011 to encourage utilization of evidence-based preventive care, including: (1) eliminating cost
sharing for all preventive care services with an A or B rating by the US Preventive Services Task Force; (2)
introducing a new annual check-up, the Annual Wellness Visit (AWV), with no cost sharing; and (3) providing a
bonus payment to primary care providers (PCPs) serving health care shortage areas. Although these policy
changes have been in effect for most of the last decade, there is limited evidence of their effectiveness to
increase cancer screening in older adults, detect more early-stage cancer cases, and reduce mortality from
CRC and BC. Additionally, utilization patterns suggest there are physician and patient factors driving use of the
AWV. However, the role of provider factors and patient self-selection on AWV utilization is unknown. The
proposed mixed-methods study seeks to understand how, and to what extent, the 2011 Medicare policy
changes have affected the burden of CRC and BC among Medicare beneficiaries. The specific aims of the
study are to: 1) qualitatively explore PCP perceptions of rationale for conducting AWVs, AWV value, and
factors influencing beneficiary self-selection to utilize the AWV; 2) estimate the effect of the global 2011
Medicare policy changes on CRC and BC outcomes and 3) estimate the effect of beneficiary-level utilization of
the AWV on CRC and BC outcomes. Using a convergent mixed-methods approach, qualitative data will help to
understand processes and provide detailed information about the context in which AWVs are being delivered.
At the point of interpretation, qualitative and quantitative findings will be compared to assess convergence,
divergence, or contradiction in the findings. This study has been designed to provide the applicant with
experience necessary to continue along the pathway to becoming an independent investigator with expertise in
primary health care access, vulnerable aging adults, and mixed-methods research designs. The proposal is
aligned with two of AHRQ’s research priority areas, elderly patients and access to care.

## Key facts

- **NIH application ID:** 9986240
- **Project number:** 1R36HS027139-01A1
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Mika K Hamer
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $43,046
- **Award type:** 1
- **Project period:** 2020-04-01 → 2021-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9986240

## Citation

> US National Institutes of Health, RePORTER application 9986240, The Effects of Expanding Medicare Prevention Coverage on Colorectal and Breast Cancer Burden: A Mixed Methods Study (1R36HS027139-01A1). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/9986240. Licensed CC0.

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