Access Challenges for Medicare Advantage Oncology Networks Revealed by Study

A recent study in JAMA Network Open identifies significant challenges Medicare Advantage (MA) beneficiaries face when accessing comprehensive oncology networks. This cross-sectional research highlights the limited scope of effective oncology networks for MA recipients compared to traditional Medicare, with only about 25% of MA plans including National Cancer Institute (NCI)-designated comprehensive cancer centers.

Leveraging data from the Surveillance, Epidemiology, and End Results–Medicare, researchers analyzed effective oncology networks from 2010 to 2019 for patients diagnosed with eight cancer types. The study particularly focused on MA beneficiaries with coverage for at least one month between 2016 and 2019.

The study examined 807,580 MA beneficiaries, covering 23,255 plan-year observations in standard plans across 980 counties and 17,716 plan-year observations in special needs plans (SNPs) across 901 counties. Researchers analyzed the breadth of effective oncology networks, assessing access to oncology organizations and professionals compared to traditional Medicare within similar regions and timeframes.

Findings revealed that while traditional Medicare participants accessed between 98 to 120 oncology organizations, MA beneficiaries utilized fewer than 11 on average. Regular MA plan beneficiaries had mean effective network access rates of 12.0% for oncology organizations, 6.8% for medical or surgical oncologists, and 11.6% for radiation oncologists. SNP participants had slightly higher rates of 12.4%, 7.2%, and 12.7%, respectively.

In visits to NCI-designated centers, 25.7% of MA visits included such centers versus 20.5% for SNPs. Despite variations, overall network breadth remained consistent over the years. Health maintenance organizations (HMOs) showed the lowest effective network breadth at 8.5% compared to local and regional preferred provider organizations (PPOs) and point-of-service (POS) plans. Surprisingly, HMOs and POS plans demonstrated higher access rates to NCI-designated centers than regional PPOs.

The study also highlighted disparities between metropolitan and non-metropolitan counties, with the latter showing a reduced likelihood of NCI-designated center visits for MA beneficiaries. These findings call for enhanced transparency, regulatory oversight, and evaluation of MA oncology networks' impact on cancer treatment access and outcomes, as suggested by the researchers.

This research was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and the UT Southwestern Medical Center Dean’s Clinical Scholar Award. Some authors disclosed conflicts of interest. For detailed insights, see the original study by Hu X, Kwon Y, Fan Q, et al., published in JAMA Network Open.