Department of Vermont Health Access - Medicaid Global Commitment (Cancer) and 2 more...less...

Policies and Systems

Vermont Medicaid (GC-17)

BCS: Breast Cancer Screening (GC-17)


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Notes on Methodology
  • The annual reported rate captures activity during the previous calendar year.  For example, the 2017 rate captures services provided during calendar year 2016.
  • This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
  • Based on the advice of their External Quality Review Organization (EQRO), DVHA’s rates only include only Medicaid Primary beneficiaries in HEDIS administrative measures as of 2014.
  • The target trend line is the 50th percentile national benchmark for Medicaid programs.
  • Medicaid beneficiaries
  • Selected Blueprint practices
  • Vermonters Taking Action Against Cancer (VTAAC)
  • Vermont Department of Health (VDH)
  • Blue Cross Blue Shield of Vermont (BCBSVT)
  • MVP
Story Behind the Curve

This measure looks at whether female Medicaid beneficiaries are being screened for breast cancer. It assesses the percentage of women between 50 and 74 years of age who had a mammogram in the last 2 years.

Breast cancer is the 2nd most common type of cancer among American women. It is most common in women over 50. Women whose breast cancer is detected early have more treatment choices and better chances for survival. Mammography screening has been shown to reduce mortality by 20-30% among women 40 and older. A mammogram can reveal tumors too small to be felt by hand; it can also show other changes in the breast that may suggest cancer.

Vermont Medicaid has been working the Vermonters Taking Action Against Cancer (VTAAC) Cancer Prevention & Detection Workgroup, the Vermont Department of Health's Comprehensive Cancer Control (CCC) Program, Blue Cross Blue Shield of Vermont, and MVP on a gap-in-care quality improvement project since 2013.  The three insurers run administrative claims data and send 28 practices a quarterly report showing all members seen at that practice and whether or not they are due for cancer screenings.  The project is being evaluted in the fall of 2017.  Results will be anaylzed to determine if/how the project will continue.

As part of the Adult Medicaid Quality (AMQ) Grant, the DVHA developed and implemented a Breast Cancer Screening (BCS) Performance Improvement Project per Centers for Medicare & Medicaid Services (CMS) protocols from 2013-2015.  The project goal was to increase the overall rate of female Medicaid beneficiaries receiving a mammogram.  Two interventions were implemented & maintained for two years, targeting the non-compliant beneficiaries (those not receiving a mammogram in the last 2 years).  One intervention was a direct mailing to beneficiaries and one intervention was to send gap-in-care reports to providers (see paragraph above).  Results for both interventions over both cycles were modest; the AMQ grant ended in 2015 so a third annual cycle was not implemented. 

In 2014, it was discovered that beneficiaries with a third party liability (TPL) insurance and beneficiaries who are dually eligible for Medicaid & Medicare have been included in the denominator of the BCS measures.  DVHA is unable to see mammogram claims for these two populations, so they would never show up in the numerator.  Therefore, DVHA began excluding beneficiaries with TPL or dual eligibility from the BCS measure in 2014.  The jump in the trend line from 40.8% in 2013 to 66.4% in 2014 is due to the change in how the rate is run.  The performance improvement project did not contribute to this increase; the interventions were not implemented until the following year.

Last updated:  August 2017

Author:  DVHA Quality Unit

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy