Disparities in Oncology Network Utilization: Medicare Advantage vs Traditional Medicare

Researchers at Vanderbilt University Medical Center have published a study highlighting disparities in oncology network utilization between Medicare Advantage (MA) plans and Traditional Medicare. Using data from the SEER Medicare database from 2016 to 2019, the study focused on beneficiaries diagnosed with common cancers, revealing significant differences in access to oncology resources.

The study found that MA plan participants had limited access to oncology networks, with regular MA plan beneficiaries utilizing around 12.0% of available oncology organizations. Access to medical or surgical oncologists was at 6.8%, while radiation oncologist interaction was at 11.6%. Those in Special Needs Plans (SNPs) experienced marginally higher access. Meanwhile, a notable percentage of MA plan participants, including a quarter of regular MA and a fifth of SNP beneficiaries, visited NCI-designated comprehensive cancer centers.

The research points to significant limitations, particularly within narrower oncology networks of Health Maintenance Organizations (HMOs) and regional Preferred Provider Organizations (PPOs), especially in nonmetropolitan areas. These restrictions in network access may pose challenges for MA plan beneficiaries seeking advanced cancer treatments. The study, available in JAMA Network Open, encourages further investigation into enhancing network accessibility. For more information, contact lead researcher Youngmin Kwon at Vanderbilt University Medical Center.