Abstract B126: Examining Medicaid-serving primary care teams and delivery context on quality of care transitions to oncology: Implications for health equity

Abstract

Abstract Purpose: Care transitions, from primary care to oncology, for Medicaid enrollees are understudied and likely contribute to quality and outcome disparities. We explore multi-team systems (MTS) (care coordination tasks and teamwork) to understand variations in breast and colorectal cancer care transitions in Medicaid-serving clinics. Methods and Materials: We conducted a comparative case study of three purposively recruited primary care clinics in New Jersey, based on clinic-level care transition performance (Medicaid enrollees’ receipt of guideline-concordant treatment). Site evaluations, conducted in 2019-2020, included observation (2-3 days) and interviews. Insights into performance variation emerged from a two-phase analytic approach. Results: Performance variations may stem from adaptations of MTS inputs and processes based on contextual factors (i.e., business model, clinic culture). Clinic 1 (average performer), part of a multi-site safety-net clinic system, mainly teamed outside of their organization, relying on designated roles, protocol-based care, and quality improvement informed by within team metrics. Clinic 2 (high performer), part of a for-profit health system, remained mission driven to improve urban health, teamed exclusively with internal teams with electronically enabled between team information exchange, and health system wide quality improvement efforts. Clinic 3, (low performer), a physician-owned private practice with minimal teaming, accepted Medicaid enrollees to diversify their payer mix and relied on referral-based care with limited consideration of social barriers. Conclusion: MTS’s adapt their care coordination in response to context. Addressing disparities in cancer care coordination for Medicaid populations should prioritize the implementation of policy that leverage clinic attributes and the boundary status of interdependent teams. Citation Format: Denalee M. O'Malley, Michelle Doose, Jenna Howard, Joel C. Cantor, Benjamin F. Crabtree, Jennifer Tsui. Examining Medicaid-serving primary care teams and delivery context on quality of care transitions to oncology: Implications for health equity [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B126.