Adapting to a Shifting Health Care Landscape: Illinois Breast and Cervical Cancer Program Lead Agencies’ Perspectives

Abstract

Understanding how safety net programs adapt to systemic health care changes is pivotal for creating feasible recommendations for policy implementation. This study characterizes perspectives of Lead Agency (LA) coordinators of the Illinois Breast and Cervical Cancer Program (IBCCP) in response to sociopolitical changes at state and national levels. Our cross-sectional study included 29 semistructured telephone interviews between December 2015 and January 2016. Respondents indicated some changes in the priority population served, changes in referrals and clinical services, and, a continued commitment to IBCCP. Our findings suggest that IBCCP and other safety net programs will need to be flexible to meet the ongoing needs of historically vulnerable populations in a complex, shifting environment. Implications for public health practice and policy include the need to ensure that program personnel are aware of evidence-based strategies to reach different priority populations and are kept abreast of organizational and system changes that may affect referral patterns as well as the need to educate health care providers working with safety net programs about changes in the delivery and coordination of services.

Keywords

cervical cancer breast cancer health care reform disparities

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References

Albright

Moreno

Thomas

Walters

Samuels

Pereira

(2011). The implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Education Education Reconciliation on cancer care delivery. Cancer, 117, 1564-1574. doi:10.1002/cncr.25725

Angier

Hoopes

Gold

Bailey

S. R.

Cottrell

E. K.

Heintzman

. . . DeVoe

J. E.

(2015). An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Annals of Family Medicine, 13, 10-16.

Bernard

Ryan

(2009). Analyzing qualitative data: Systematic approaches. Thousand Oaks, CA: Sage.

Bitler

Hoynes

(2016). The more things change, the more they stay the same? The safety net and poverty in the Great Recession. Journal of Labor Economics, 34(S1), S403-S444.

Boubacar

Foster

(2014). Analysis of small business owners’ perception of the Patient Protection and Affordable Care Act: Evidence from Wisconsin farmers. Economics, Management, and Financial Markets, 1, 11-20.

Carmen

Eibner

Paddock

(2016). Trends in health insurance enrollment, 2013-2015. Health Affairs, 34, 1044-1048. doi:10.1377/hlthaff.2015.0266

Choi

Adams

Eberth

Brandt

Friedman

Tucker-Seeley

. . . Hébert

(2015). Medicaid coverage expansion and implications for cancer disparities. American Journal of Public Health, 105(Suppl. 5), S706-S712.

Cooper

Kou

Schluchter

Dor

Koroukian

(2015). Changes in receipt of cancer screening in Medicare beneficiaries following the Affordable Care Act. Journal of the National Cancer Institue, 108, djv374. doi:10.1093/jnci/djv374

Cristofalo

M. A.

(2014). Weaving strengths and vulnerabilities: Implementing evidence-based practices in core safety net settings (Doctoral dissertation). University of Washington, Seattle, WA.

10.

Daly

Olopade

(2015). A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA: A Cancer Journal for Clinicians, 65, 221-238. doi:10.3322/caac.21271

11.

Eheman

Leadbetter

Benard

Blythe Ryerson

Royalty

Blackman

. . . Babcock

(2014). National Breast and Cervical Cancer Early Detection Program data validation project. Cancer, 120(Suppl. 16), 25297-22603. doi:10.1002/cncr.28825

12.

Espey

Castro

Flagg

Landis

Henderson

Benard

Royalty

(2014). Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native women and the National Breast and Cervical Cancer Early Detection Program. Cancer, 120(Suppl. 16), 2557-2565. doi:10.1002/cncr.28824

13.

Fedewa

Goodman

Flanders

Han

Smith

Ward

. . . Jemal

(2015). Elimination of cost-sharing and receipt of screening for colorectal and breast cancer. Cancer, 121, 3272-3280. doi:10.1002/cncr.29494

14.

Glaser

Strauss

Strutzel

(1968). The discovery of grounded theory: Strategies for qualitative research. Nursing Research, 17, 364.

15.

Gordon

(2012). State and local budgets and the Great Recessioon. Retrieved from https://www.brookings.edu/articles/state-and-local-budgets-and-the-great-recession/

16.

Hall

M. A.

(2011a). The mission of safety net organizations following national insurance reform. Journal of General Internal Medicine, 26, 802-805.

17.

Hall

M. A.

(2011b). Rethinking safety-net access for the uninsured. New England Journal of Medicine, 364, 7-9.

18.

Hamman

Kapinos

(2015). Affordable Care Act Provision lowered out-of-pocket cost and increased colonoscopy rates among men in Medicare. Health Affairs, 32, 2069-2076. doi:10.1377/hlthaff.2015.0571

19.

Han

Yabroff

Guy

Zheng

Jemal

(2015). Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States? Preventive Medicine, 78, 85-91. doi:10.1016/j.ypmed.2015.07.012

20.

Hom

Wong

Stillson

Zha

Cannuscio

Cahill

Grande

(2016). New Medicaid enrollees see health and social benefits in Pennsylvania’s expansion. Inquiry: The Journal of Health Care Organization, Provision, and Financing, 53, 1-8.

21.

Hsieh

Shannon

(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277-1288. doi:10.1177/1049732305276687

22.

Kamimura

Ashby

Trinh

Prudencio

Mills

Tabler

. . . Reel

(2016). Uninsured free clinic patients’ experiences and perceptions of healthcare services, communtiy resources, and the Patient Protection and Affordable Care Act. Patient Expeirence Journal, 3, 12-21.

23.

Kim

Chukwudozie

Calhoun

(2013). Sociodemographic characteristics, distance to the clinic, and breast cancer screening results. Journal of Health Disparities Research and Practice, 6, 70.

24.

Jones

Shin

Byrne

F. R.

Long

S. K.

(2011). Safety-net providers after health care reform: lessons from Massachusetts. Archives of Internal Medicine, 171, 1379-1384.

25.

Lantz

P. M.

Keeton

Romano

DeGroff

(2004). Case management in public health screening programs: The experience of the national breast and cervical cancer early detection program. Journal of Public Health Management and Practice, 10, 545-555.

26.

Lantz

P. M.

Mullen

(2015). The National Breast and Cervical Cancer Early Detection Program: 25 years of public health to low-income women. Cancer Causes & Control, 26, 653-656. doi:10.1007/s10552-015-0565-9.

27.

Levano

Miller

J. W.

Leonard

Bellick

Crane

B. E.

Kennedy

S. K.

. . . Tharpe

F. S.

(2014). Public education and targeted outreach to underserved women through the National Breast and Cervical Cancer Early Detection Program. Cancer, 120(Suppl. 16), 2591-2596. doi:10.1002/cncr.28819

28.

Levy

Bruen

Leighton

(2012). Health care reform and women’s insurance coverage for breast and cervical cancer screening. Preventing Chronic Disease, 9, E159. doi:10.5888/pcd9.120069

29.

Morse

(2015). Analytic strategies and sample size. Qualitative Health Research, 25, 1317-1318.

30.

Mukem

Meng

Sriplung

Tangcharoensathien

(2015). Low coverage and disparities of breast and cervical cancer screening in Thai women: Analysis of national representative household surveys. Asian Pacific Journal of Cancer Prevention, 16, 8541-8551. doi:10.7314/apjcp.2015.16.18.8541

31.

Nelson

Weerasinghe

Wang

Grunkemeie

R. G.

(2015). Mammography screening in a large health system following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act. PLoS One, 10, e0131903.

32.

Ooi

Martinez

(2011). Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Research and Treatment, 127, 729-738. doi: 10.1007/s10549-010-1191-6

33.

Redlener

Grant

(2009). America’s safety net and health care reform—what lies ahead?. New England Journal of Medicine, 361, 2201-2204.

34.

Reiter

K. L.

Jiang

H. J.

Wang

(2014). Facing the recession: How did safety-net hospitals fare financially compared with their peers?. Health Services Research, 49, 1747-1766.

35.

Rittenhouse

D. R.

Shotell

S. M.

Fisher

E. S.

(2009). Primary care and accountable care: Two essential elements of delivery-system reform. New England Journal of Medicine, 361, 2301-2303. doi:10.1056/NEJMp0909327

36.

Sanders

Larkins

Boyle

George

Triplett

Leypoldt

(2014). National Breast and Cervical Cancer Early Detection Program partnerships in action. Cancer, 120(Suppl. 16), 2612-2616. doi:10.1002/cncr.28827

37.

Simmons

Skopec

(2012). 47 million women will have guaranteed access to women’s preventive services with zero cost-sharing under the Affordable Care Act. Retrieved from https://aspe.hhs.gov/basic-report/47-million-women-have-guaranteed-access-womens-preventive-services-zero-cost-sharing-under-affordable-care-act

38.

Sommers

Arntson

Kenney

Epstein

(2013). Lessons from early Medicaid expansions under health reform: Interviews with Medicaid officials. Medicare Medicaid Research Review, 3, E1.

39.

Yancy

Royalty

Marroulis

Mattingly

Benard

DeGroff

(2014). Using data to effectively manage a national screening program. Cancer, 120(Suppl. 16), 2575-2583. doi:10.1002/cncr.28821