Activity Report Michigan Cancer Surveillance Program

1. Activity ReportMichigan Cancer Surveillance Program October 14, 2005 Michigan Tumor Registrars Association

2. Topics to be covered • Review of Ongoing Studies • Status of Cost of Care Project • Trends in Prostate Cancer • Cancer Survival Data for Michigan

3. Kidney Lung Hepatoblastoma Childhood Leukemia Radiological Technicians Adventist Study HIS Black Women's Health Study Hypoplastic Breast Racial Disparities and Prostate Cancer Family History Melanoma Arsenic Survivors II Cost of Care Studies Completed or Ongoing2004-2005

4. Survivors Study II • American Cancer Society • Frank Baker, PhD and Kevin Stein, PhD • Ongoing in 14 States • Identify and Recruit Eligible Patients • Study of Cancer Survivors • 2, 5 and 10 year survivors • Breast, Prostate, Colorectal, Bladder, Melanoma, Uterine Cancers • Questionnaire • Quality of Life • Psychosocial Functioning

5. Arsenic Exposure and Bladder Cancer in Michigan • Jerome Nriagu, Ph.D., Dept of Environmental Health Sciences, School of Public Health – UM –NCI • Investigation of Naturally Occurring Arsenic in Drinking Water • Case Control Study of Bladder Cancer in 11 County Area • Bladder Cancer Survivor • 2000-2003 • 21 – 80 Years of Age • 5 years in Region

7. Clinical and Cost Database Establishing a Statewide Database for Breast, Cervical, Colorectal, Lung, and Prostate Cancers

8. Goal:By 2005, develop the linked economic and clinical database infrastructure necessary to support data-driven decisions for control of breast, cervical, colorectal, lung, and prostate cancers within the state of Michigan.

9. Problem/Need We don’t understand relative costs and health outcomes for cancer prevention, early detection, and treatment There is no single, centralized, statewide database that contains economic and clinical data for breast, cervical, colorectal, prostate, and lung cancer

10. Problem/Need These data would facilitate: • informed decision-making by policy-makers, providers, health care systems re: clinical and cost implications of decisions • efficient distribution of limited cancer control resources

11. 2 Steps: • Determine feasibility, usefulness, and affordability of a centralized database • Establish/maintain centralized cancer database

12. 1. Determine Feasibility, Usefulness, Affordability Objective #1: Implement and evaluate a pilot demonstration to determine the feasibility, costs, and benefits of merging cancer-related cost and clinical elements from multiple databases.

13. 1. Determine Feasibility, Usefulness, Affordability Objective #2: Implement and evaluate an expanded pilot demonstration to match statewide claims data (both cancer and non-cancer care) from all Blue Cross plans and the Michigan Medicaid Program to clinical data from the Michigan Cancer Registry.

14. 1. Determine Feasibility, Usefulness, Affordability Objective #3: Implement and evaluate a statewide field test that adds claims data from Medicare, other managed care plans, self-insured plans, and other major health care payers in Michigan to the statewide cancer database demonstration process.

15. 2. Establish/Maintain a Centralized Cancer Database Objective #1: If determined to be feasible, useful, and affordable, implement a standing, comprehensive, statewide economic and clinical database for breast, cervical, colorectal, lung, and prostate cancers in Michigan.

16. Cost of Cancer Care Database Progress Report to the MCC Board of Directors September, 14, 2005

17. Acknowledgements to Co-presenters Huda Fadel, Ph.D., BCBSM Sue Haviland, DCH, Comp. Cancer Charles Given, Ph.D., MSU Cathy Bradley, Ph.D.,VCU

18. Objectives • Is database of value to analysis of : • Cancer Control Issues • Health Plan Administration • Cancer Case Management • Is developing/maintaining a statewide database: • Feasible • Affordable • Sufficient Quality • Does database augment registry treatment data ? • Improve Hospital Data? • Augment Outpatient Information?

19. Accomplishments • Cancer Registry Link to Medicaid 96-97 • Used for a series of analyses • Cancer Registry Link to BCBSM 96-98 • Demonstrated technical feasibility • Registry to Medicare/Medicaid 96-2000 • Nearly Finalized • Working on Registry to BCBSM 1998-2002 • Due this Fall • Agreements – Link to Medicaid Encounter • Pending BCBSM Finalization

20. Collaborators • Cancer Control Section – DCH • Michigan Cancer Surveillance Program – DCH • Cathy Bradley, Bill Given – MSU • Blue Cross/Blue Shield MI – Huda Fadel • Medicaid – DCH • Michigan Association of Health Plans • CDC – National Program of Cancer Registries • NCI – Health Services and Economics Branch

21. Directions • All Sites vs. Selected Sites • Multiple Confidentiality Levels • Patient, Provider, Plan • Cancer Free Controls

22. Current Tasks • Finalize Linked File of Dually Eligible Medicare/Medicaid Study Files • Develop and Evaluate Quality of BCBSM/Registry File • Initiate Work on Registry/Managed Care Medicaid Patients

23. Linking Cancer Registry Data to Claims Data from BCBSM - Project History 2001 2002 2004 2005 2003 Policies & procedures for research; training Request T. Simmer, MD Work begins Work begins again! Prelim results Address privacy & contracting HIPAA Contract w/ MDCH IRB sign

24. Blue Cross Blue Shield of Michigan • Non-profit health insurance company • 54% commercial market share within Michigan. The next largest competitor has a 6% share Health Care Enrollment by Product

25. BCBSM - Insurance Products

26. BCBSM Membership Summary Top 10 customers • General Motors • Ford Motor Company • Michigan Public School Retirees • MESSA • State of Michigan • DaimlerChrysler • Detroit Regional Chamber • Federal Employee Program (FEP) • Small Business Association of Michigan

27. Membership by Age

28. Pilot Project Overview MI Cancer Surveillance Registry BCBSM Claims & Admin Files Demographics Outcomes Clinical Information Treatment Information Economics MI Mortality File

29. Pilot Link to BCBSM Process • Membership file to DCH – 1998-2002 • Link to Registry • Identify Cases • Develop Study Cohort • Select matched “cancer free”controls • Return Study Cohort to BCBSM • Pull Claims • DCH Receives Claims Data • Develop Linked De-Identified Study Files • Forward Study File to BCBSM for Analysis

30. Key Steps • Pilot Proposal • Contract with BCBSM/DCH • DCH IRB Approval • DCH Designated as IRB for BCBSM • Partial CDC Funding for BCBSM

31. Status • All Agreements in Place • Preliminary Link to BCBSM • Data Set Defined • BCBSM Developed Membership File • DCH Developing Linkage Strategy • Developing Approach to Quality Analysis

32. Preliminary Link • Enrollment File for 1998-1999 • 4.8 Million Participants • Linked to Registry • Probabilistic Match • Identified 32,000 Cases • Above expectation

33. Medicaid/MedicareEligibility Data • Medicaid eligibility for coverage can change on a monthly basis • Medicaid eligibility can include: • total coverage of medical costs • secondary coverage after other insurance, • Medicare co-payments and premiums • Medicare eligibility can include: • Part A (inpatient) and/or Part B (outpatient) • Indications of supplemental insurance • Provider information • Eligibility data must be linked to claims data to determine if beneficiaries were covered at time of diagnosis

34. Comparisons of Cancer Incidence 1996-2000 • Establishing Cancer Incidence is essential to achieving other policy and research goals • Annual Incidence describes changes in detection and how these rates differ for dually eligible and Medicare only and by race and gender.

36. Differences in Profiles of Medicare only and Dually Eligible Population by Age and Gender

37. Medicaid Eligibles in Long Term Care at Diagnosis by Gender and Age Group Medicaid Paying for long term care increases eligibility rates for older population, especially women

38. Comparing Overall Incidence of Cancer in Medicare Only and Dually Eligibiles from 1996-2000

39. Incidence of Cancer in Medicare only and Dually Eligibiles from 1996-2000 Notice difference in Incidence scales

40. Incidence of Cancer in Medicare Only and Dually Eligibiles from 1996-2000

41. Incidence of Cancer in Medicare only and Dually Eligibiles from 1996-2000

42. Incidence of Cancer in Medicare only and Dually Eligibiles from 1996-2000

43. Incidence Rates • Do incidence rates also vary significantly by age groups? • For these groups the number of cancers and sizes of the populations are small • Calculated rates over whole 5 year period to reduce variation

44. Changes in Cancer Incidence Rates by Age Group

45. Changes in Cancer Incidence Rates by Age Group

46. Changes in Cancer Incidence Rates by Age Group

47. Changes in Cancer Incidence Rates by Age Group

48. Changes in Cancer Incidence Rates by Age Group

49. Changes in Cancer Incidence Rates by Age Group

50. What are the Effects of Race on Incidence • A higher proportion of Blacks in Medicaid than in the Medicare only population • Because there are so few cases, especially of black males, average incidence rates were calculated over the entire 5 years study