Cary Gross, MD

Cary Gross, MD, professor of medicine and of epidemiology, and founder and director, the Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine; director, Adult Primary Care Center, Quality Improvement; chair, National Clinician Scholars Program; and director, National Clinician Scholars Program, discusses the background of his research on patients with lung cancer and Medicaid.

In the American healthcare system, Medicaid is one of the largest public health insurance programs with about 1 in 5 Americans having its coverage. A study led by Gross et al compared Medicaid patients with private insurance patients.

Investigators aimed to evaluate this topic as previous studies have suggested that patients with cancer who have Medicaid end up experiencing lower quality of care vs patients who are privately insured.

The reason my authors and I set out to study the relation between Medicaid and the quality of lung cancer care is that Medicaid is a vitally important player in the American healthcare system. It's our nation's largest public health insurance program and covers approximately 1 in 5 Americans. For our study, that comparator was patients with private insurance.

But what I wanted to be clear about is that Medicaid is far better than having no insurance. Many studies have shown that patients with Medicaid have better access to care than the uninsured. Patients with Medicaid are more likely to get high quality care and have higher satisfaction than patients who are uninsured. So, I wouldn't want anyone to look at our study and say, “I guess Medicaid is not that good,” or “Let's get rid of Medicaid.” That's not what we're talking about. This is a study of Medicaid versus private insurance. And the reason why we set out to explore Medicaid is because prior studies have suggested that patients with cancer and Medicaid experience lower quality of care than patients who are privately insured.

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Cary Gross, MD, discusses the background of his research on patients with lung cancer and Medicaid.


Evaluating Quality of Care for Patients With Medicaid vs Private Insurance 

Cary Gross, MD, discusses the key takeaways from his retrospective research examining patients with advanced non–small cell lung cancer (NSCLC) and its association with Medicaid insurance, rates of biomarker testing, and patient outcomes.

In the study, researchers examined 6,145 commercially insured and 865 Medicaid beneficiaries with advanced NSCLC, all who had received their diagnosis between January 2011 to September 2019.

Data was collected from a nationwide US healthcare database and revealed that Medicaid beneficiaries were less likely to get biomarker testing (HR, 0.81; P < .001), any first-line treatment (HR, 0.72; P < .001), or first-line biomarker-driven therapy (HR, 0.70; P < .001) compared with commercially insured patient

Medicaid beneficiaries were also more likely to be Black (20%) or African American (9.3%, P < .001), and showed they were less likely to undergo biomarker testing at 57% vs 71% (P < .001). Findings revealed many testing disparities and highlighted the fact that patients may not be getting the levels of biomarker testing they need to ensure better outcomes.

Often, we tend to think of policy just as something that happens maybe in Washington, DC, and clearly we need to advocate for improvements and change to our Medicaid program. I mentioned earlier that this other study found that many hospitals don't accept Medicaid patients. One reason behind that may be because Medicaid reimburses much less than private insurance. At the big picture of policy level, we need to advocate for improvements to the Medicaid program. That may be focused around increasing reimbursement rates to ensure that these patients are able to get into any clinic and hospital they need to.

Also though, I think this is an opportunity for the medical establishment to think where are they? Where are we as individuals? Where are we as individual practices for hospitals? Where do we stand regarding health equity, and are we seeing Medicaid patients as promptly as our commercial patients? Are we ensuring that our patients with Medicaid have access to appropriate testing and treatment?

 I would just argue that sometimes advocacy also happens at the individual patient by patient level, so it's not only about politics, it's about advocating for our patients who are trying to get into our doors and in the hospitals. I think these findings are a call to action both for policymakers, but also just for food for thought for what we can do to advocate at our local level.

Cary Gross, MD, discusses the key takeaways from his retrospective research examining patients with advanced non–small cell lung cancer and its association with Medicaid insurance, rates of biomarker testing, and patient outcomes.

Cary Gross, MD | Authors

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Evaluating Quality of Care for Patients With Medicaid vs Private Insurance

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