Reducing unnecessary breast cancer care and costs in Medicare
Evaluating Use and Expenditures on Low Quality Breast Cancer Care in the Medicare Program
['FUNDING_R01'] · GEORGETOWN UNIVERSITY · NIH-11343796
This project looks at which tests and treatments people with early-stage breast cancer on Medicare receive that may be unnecessary, and how Medicare Advantage plan rules might lower those low-value services.
Quick facts
| Phase | ['FUNDING_R01'] |
|---|---|
| Study type | Nih_funding |
| Sex | All |
| Sponsor | GEORGETOWN UNIVERSITY (nih funded) |
| Locations | 1 site (WASHINGTON, UNITED STATES) |
| Trial ID | NIH-11343796 on ClinicalTrials.gov |
What this research studies
Researchers will analyze Medicare billing and claims to identify specific tests, imaging, and procedures for early-stage breast cancer that offer more harm than benefit. They will compare how often these low-value services are used and how much is spent in traditional Medicare versus Medicare Advantage plans. The team will examine whether plan tools like prior authorization or network incentives are linked to lower use of these services. Findings will point to where policy or program changes could reduce unnecessary care and costs for patients.
Who could benefit from this research
Good fit: Ideal candidates for the findings are Medicare beneficiaries with early-stage breast cancer, including those in traditional Medicare and Medicare Advantage plans.
Not a fit: People under 65, those without Medicare coverage, or patients with advanced/metastatic breast cancer are unlikely to be directly affected by this research.
Why it matters
Potential benefit: If successful, this work could lower unnecessary tests and procedures, reducing side effects and out-of-pocket costs for Medicare patients with early-stage breast cancer.
How similar studies have performed: Prior campaigns like Choosing Wisely raised awareness but had limited impact on reducing low-value care, and this project builds on claims-based measures while focusing on Medicare Advantage tools that are less tested.
Where this research is happening
WASHINGTON, UNITED STATES
- GEORGETOWN UNIVERSITY — WASHINGTON, UNITED STATES (ACTIVE)
Researchers
- Principal investigator: MITCHELL, JEAN M — GEORGETOWN UNIVERSITY
- Study coordinator: MITCHELL, JEAN M
About this research
- This is an active NIH-funded research project — typically early-stage science, not a clinical trial accepting patient enrollment.
- Some NIH-funded labs run parallel clinical studies or seek volunteers for related work. To check, contact the principal investigator or institution listed above.
- For full project details, budget, and progress reports, visit the official NIH RePORTER page below.
Conditions: Breast Cancer