Can Patient-centered Medical Homes Reduce Costs for Low-income Cancer Patients?

An estimated two in five cancer patients have at least one chronic condition. Patient-centered medical homes (PCMHs) are designed to provide patients with a multipronged treatment approach, allowing for comprehensive medical care. A study published in the November 1 issue of Cancer found that while PCMHs may not be correlated with improved chronic disease medication adherence, low-income cancer patients in PCMHs may experience reduced costs and lower visits to the emergency department (ED).

The researchers used linked North Carolina cancer registry and claims data spanning 2004 through 2014 on Medicaid enrollees with a diagnosis of breast, colorectal, or lung cancer and hyperlipidemia, hypertension, and/or diabetes. Difference-in-difference methods were implemented to assess chronic disease medication adherence in patients with and without cancer. A differences‐in‐differences‐in‐differences approach was utilized to assess the effect of PCMH enrollment on differences between patients with versus without cancer. Additional outcomes included changes in healthcare expenditures and use.

Newly diagnosed cancer patients with hyperlipidemia, compared to non-cancer patients, had a 7- to 11-percentage point decrease in the percentage of days covered. Cancer patients, compared to those without cancer, had significant increases in medical expenditures and hospitalizations.

PCMH status did not appear to affect changes in medication adherence between patients with versus without cancer. In PCMH patients with cancer, compared to non-PCMH cancer patients relative to non-cancer patients, those with diabetes had smaller increases in expenditures, and those with hyperlipidemia had smaller increases in ED use, but hypertension patients had larger increases in inpatient hospitalization rates.

The study is significant because chronic conditions can have serious effects on cancer patients, the study authors noted.

“Survivors of nonmetastatic cancer are more likely to die of other causes, such as cardiovascular disease, than of cancer, thereby highlighting the importance of long‐term adherence to medications for conditions comorbid to cancer diagnoses,” they explained. “In addition, cancer survivors with diabetes live on average 5 years less than those without diabetes, further illustrating the importance of continuous primary care.”

The researchers concluded, “Given the demonstrated potential for low‐income patients with cancer with chronic conditions to have worse adherence to their chronic medications, higher costs, and higher health care use around the time of their cancer diagnosis, future studies should examine a variety of approaches that can help to mitigate the multidimensional burden of cancer in low‐income populations.”