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For colon and breast cancers, use of evidence-based practice guidelines may decrease the total per member per month (PMPM) cost for individuals with cancer. For colon cancer, the PMPM total cost of care (TCOC) was 33% lower for Medicare beneficiaries who received care that aligned with the treatment guidelines established by the National Comprehensive Cancer Network (NCCN). For breast cancer, the PMPM TCOC was 43% lower for Medicare beneficiaries whose care aligned with the NCCN guidelines.

Among Medicare beneficiaries whose colon cancers were treated following the NCCN guidelines, the TCOC was $2,986 PMPM lower than for those whose . . .

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The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

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