Research We Fund

Patients with blood cancers from racial and ethnic minority groups are more likely to experience suboptimal end-of-life (EOL) care. These disparities may be partially driven by health insurance differences but there is limited research examining insurance access as a potential contributor to EOL care disparities for this population. We will leverage complementary local and national datasets to assess the relationship between insurance status and type with EOL quality measures. We will also develop a Blood Cancer Health Insurance Initiative to translate our research findings to policy initiatives to dismantle disparities in access to high-quality EOL care for patients with blood cancers. We will translate our research findings to policy initiatives to dismantle disparities in access to high-quality EOL care for patients with blood cancers.

This project will evaluate the association of insurance type with insurer rejection and patient abandonment of new OAM prescriptions for blood cancers, overall and by sociodemographic factors. It will also evaluate the association of cost sharing with patient abandonment of OAM prescriptions for blood cancers and conduct simulations under alternative cost sharing scenarios to inform policy reform proposals among commercially insured enrollees. Finally, the study will evaluate the effect of cost-sharing reductions under the Inflation Reduction Act on patient abandonment of new OAM prescriptions for blood cancers among Medicare Part D enrollees, overall and by sociodemographic factors.

In this proposal we will investigate the association between insurance coverage and access to care, survival, and financial hardship among patients across Non-Hodgkin lymphoma (NHL) subtypes and to what extent insurance coverage explains and modifies racial disparity in access to care and outcomes. To this end, we will use the Optum Clinformatics DataMart database, the Texas Cancer Registry, the Harris Health System Cancer Database and Data from the Lymphoma Epidemiology of Outcomes (LEO) Cohort Study. These four databases will provide a sample that covers a diverse patient population in terms of insurance coverage, race and ethnicity, and geographic regions. The LEO Cohort Study also provides information on self-reported financial toxicity that is not available in cancer registries, administrative claims data, or surveys. This study will reveal whether insurance coverage, neighborhood socioeconomic factors and healthcare resources are associated with access to care and outcomes of NHL patients.

Our study is designed to directly inform the pathways through which health insurance influences access to care at an SCC for individuals with AYA ALL using a combination of cancer registry, survey, and cost-benefit analyses. This research will contribute to knowledge of the implications of health insurance coverage on ALL cancer care in young adults and inform policy-relevant solutions, including determining whether patients are bypassing an SCC for treatment at a more distant facility, calculating estimates of insurance acceptance and access challenges at ALL treating facilities and identifying the financial implications of shifting care to SCCs with demonstrated survival improvements for this population.