Optimizing Medicaid Managed Care to Improve Access, Quality, and Clinical Outcomes for Patients with Gastrointestinal Cancers

This goal of this K08 is to provide mentorship, training, and applied research opportunities for Dr. Aaron Dawes to help him become an independent investigator with a focus on access and quality of specialty cancer care. In the wake of the Affordable Care Act, millions of Medicaid enrollees with cancer have been transitioned into comprehensive managed care plans with unknown effects on access, quality, and clinical outcomes. In fact, managed care has quickly become the most common type of Medicaid coverage nationwide (currently at over 85% of enrollees) despite significant concerns from prior literature regarding increased wait times and limited access to specialty care. This research examines the impact of Medicaid managed care (MMC) on the treatment and clinical outcome of patients with gastrointestinal cancers, who may be at increased risk of harm from MMC due to their reliance on timely and coordinated access to complex and often costly health services to prevent the progression of their disease. All three aims leverage a natural experiment in California in which counties transitioned from fee-for-service to MMC at different times and utilize a unique data set that links the California Cancer Registry to Medicaid claims and county-level enrollment data from the California Department of Health and Human Services. Aim 1 will quantify the causal effect of the transition on measures of access, quality, and clinical outcomes using a difference-in-differences approach. Aim 2 explores three specific factors that may make patients more susceptible to the effects of MMC (cancer type, sex, and area-level social disadvantage) using a heterogenous treatment effects framework. Aims 1-2 are designed to measure the potential causal effects of MMC and to identify patients who may bear the largest burden of the transition; Aim 3, on the other hand, evaluates the role of provider networks, a novel and promising pathway linking MMC and patient outcomes in ways that may yield actionable targets for policy intervention. This research closely aligns with the goals of NCI’s Healthcare Delivery Research and Health Disparities and Health Equity Programs and will lay the groundwork for an entire line of future research focused on optimizing, regulating, and re-designing the Medicaid program in order to make it more efficient and more equitable. Dr. Dawes is a colon and rectal surgeon, a health policy researcher, and an Assistant Professor at Stanford University. He has four key training goals for this award: 1) to become proficient in the use of causal inference modeling to evaluate policy changes, 2) to develop an expertise in health insurance design with a specific focus on Medicaid managed care, 3) to gain applied skills in cancer epidemiology, and 4) to establish a practical foundation in the use of geospatial techniques to measure access to cancer care. Completion of these aims and the associated training plan will provide Dr. Dawes with the preliminary data and relevant experience that he needs to become an independent investigator studying and working to improve access and quality of specialized cancer care for our most vulnerable populations. Project Number: 1K08CA301027-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Aaron Dawes | Institution: STANFORD UNIVERSITY, STANFORD, CA | Award Amount: $212,332 | Activity Code: K08 | Study Section: Special Emphasis Panel[ZRG1 CTH-K (83)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11301426