Cancer Prevention and Control Medicare Claims Analysis Case Study

Client question

A client wanted to understand cancer prevention and control opportunities using claims-based evidence. The work needed to identify where screening rates were low, where providers were available, and how cancer-related procedures and treatment patterns varied by geography.

FastHSR used Medicare claims to translate cancer prevention and control questions into measurable rates, provider counts, procedure patterns, and geographic dashboards.

Colorectal cancer screening example

Colorectal cancer can be screened through stool tests such as gFOBT, FIT, and FIT-DNA; flexible sigmoidoscopy; colonoscopy; and CT colonography. FastHSR used Medicare claims to identify screening services, calculate colorectal cancer screening rates, and map providers of colonoscopy and flexible sigmoidoscopy.

The Henrico example summarized colorectal cancer screening rates and provider availability at a local geographic level. Screening-rate categories included missing values, lower-screening areas, mid-range areas, and higher screening areas, while provider markers showed where colonoscopy capacity was concentrated.

Provider and geography analysis

Cancer prevention is partly a geographic access problem. Claims data can show where screening occurs, which providers deliver screening procedures, and where low screening rates overlap with limited provider availability.

• Screening rates by local geography.
• Provider counts and service volume for colonoscopy and flexible sigmoidoscopy.
• Comparison of screening rates across neighboring areas.
• Identification of prevention gaps where provider availability and screening rates do not align.

Cancer treatment pattern example

FastHSR also used Medicare fee-for-service claims to examine breast cancer treatment patterns, including lumpectomy, mastectomy, and reconstruction providers by county. This type of analysis helps cancer-control teams understand where procedures are performed, which organizations and providers participate, and how treatment access varies across regions.

Claims data methods

Medicare claims supported the analysis because they include procedure codes, provider identifiers, service dates, beneficiary geography, care settings, and longitudinal utilization. Those fields made it possible to create population-level prevention and treatment measures rather than relying only on survey or registry snapshots.

• Identify eligible Medicare beneficiaries and local geographies.
• Use claims procedure logic to detect colorectal cancer screening services.
• Calculate screening rates and classify geographic areas by performance bands.
• Map providers and organizations delivering screening and cancer-related procedures.
• Measure treatment patterns such as lumpectomy, mastectomy, and reconstruction.

Deliverables

• Claims-based colorectal cancer screening rate calculations.
• Local maps of screening variation and provider availability.
• Provider and organization lists for relevant screening or cancer-treatment procedures.
• County-level or local geography dashboards for cancer prevention and control planning.
• Medicare claims methods documentation for reproducibility.

Use cases

• Cancer prevention strategy and outreach planning.
• Local colorectal cancer screening improvement.
• Provider network and access analysis.
• Cancer-control program evaluation.
• Breast cancer treatment pattern mapping.
• Population health dashboards for public health and healthcare organizations.

Frequently asked questions

How can Medicare claims support cancer prevention and control analytics?

Medicare claims can identify cancer screening services, procedure types, providers, geography, treatment patterns, and follow-up care across large populations.

How can claims data measure colorectal cancer screening?

Claims data can identify stool tests, colonoscopy, flexible sigmoidoscopy, CT colonography, and related colorectal cancer screening procedures, then calculate screening rates by geography or provider market.

Why map screening providers with claims data?

Provider mapping helps identify where screening services are available, which providers perform procedures, and where geographic access gaps may contribute to lower screening rates.

What cancer treatment patterns can Medicare claims measure?

Medicare claims can measure treatment patterns such as surgery type, reconstruction, facility and provider participation, geography, follow-up care, and longitudinal utilization after diagnosis or treatment.

For cancer prevention claims analysis, colorectal cancer screening analytics, provider mapping, or cancer-control dashboards, please email us.

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