Earlier Cancer Screening Could Ease Medicaid Costs: Anuraag R. Kansal, PhD

On a recent Managed Care Cast episode, Anuraag R. Kansal, PhD, who leads health economics research at GRAIL, spoke with The American Journal of Managed Care^® (AJMC^®) about his study, “State Medicaid Budgetary Implications of New Cancers," published in the July 2026 issue. The research examined how new cancer diagnoses affected state Medicaid budgets.

During the conversation, Kansal discussed how the study, conducted with Amanda C. Chen, PhD, and David C. Grabowski, PhD, analyzed Medicaid spending among patients with newly diagnosed cancers, comparing metastatic and non-metastatic diagnoses using CMS claims data and statistical adjustments to account for differences in patient characteristics and cancer types.

The study found that metastatic cancer diagnoses were associated with significantly higher spending across most cancer types, with similar patterns of health care use across Medicaid payment models. Kansal emphasized the importance of expanding access to cancer screening and timely diagnosis as potential strategies to reduce clinical and financial burdens while helping Medicaid programs maintain sustainable access to innovative treatments.

This transcript has been lightly edited for clarity.

AJMC: What were the primary objectives of your study, and what methods did you use to investigate them?

Kansal: In this study, we really focused on individuals whose cancer journey begins in the Medicaid program. Those are new cancer diagnoses that we could actually observe, and the method we used for that was actually just looking back 6 months to see if we saw any evidence of cancer prior to the diagnosis date, considering only those individuals who had new cancer diagnoses.

Our objective was to really quantify the spending in the program on these individuals with the new diagnoses and understand how it differed when the cancer was metastatic at the time of the diagnosis vs not. That's a signal; that's an indication of whether this is a cancer that was found relatively late or whether this is one that was found early in its progression.

What we really relied on were data sets that are made available through CMS. These data sets contain what's called claims data, and that's a listing of actual individual procedures and diagnoses that are received and the payments that are associated with those procedures. The data sets are deidentified, which means that all identifying information, anything that could be used to track back to individuals, is completely removed from these. The study was reviewed by the Harvard Medical School Institutional Review Board to ensure that there was no risk to patient privacy, but these data sets are very rich, even once we've done that deidentification process.

We can compare the differences in individuals whose diagnoses were consistent with metastatic vs non-metastatic cancer and then use statistical adjustments to account for differences in the characteristics of the groups. Looking at that allows us to really understand the observed difference in spending between these 2 groups and try to localize that difference to the metastatic diagnosis vs non-metastatic diagnosis.

One other thing is that because we're looking at individuals where we can see the start of their cancer journey, the diagnosis is happening within the Medicaid program, and we also wanted to understand how much we could see the full length of that journey. We looked at disenrollment data in a subset of patients, that dual-eligible group, so we could understand how many people who've started on this journey who were diagnosed with cancer on the Medicaid program ultimately disenrolled from Medicaid or otherwise achieved different coverage afterward.

AJMC: Next, can you summarize the study's main findings? Were there any results that particularly stood out to you?

Kansal: The core result of the study is that spending on metastatic diagnoses was higher than matched spending on non-metastatic diagnoses. Looking at the same patient characteristics and looking at the same cancer type, which is very important when making these types of comparisons, we see statistically significant differences in most cancer types. This was the core finding. This is what we were looking at. That was our number one objective.

But a result that really stood out to me is how consistent the use of health care was between what are called fee-for-service states and non-fee-for-service states. Medicaid can be administered in different ways, and one way is that the program is paying essentially on a procedure basis; that's a fee-for-service state. Another way is that it's paying on what's called a capitated basis, which means it's paying for the patient but not on a procedure basis. That's non-fee-for-service; it's a very different model of how treatment is delivered and managed.

Yet, when we look at individuals with cancer, when we look at individuals with non-metastatic diagnoses and individuals with metastatic diagnoses, we are seeing very similar rates of emergency room use and very similar rates of hospitalizations when we compare the fee-for-service and non-fee-for-service states. That tells us a lot about what cancer is. It's a very challenging condition to manage. There are pathways that physicians follow to manage that.

So, we see this consistency: once the diagnosis is made, here's what's likely to happen to individuals on average. Of course, every individual's journey is going to be different. But on average, there's a real consistency, despite quite substantial differences in how the programs are managed. I think that has a lot of implications for understanding that it's about the diagnosis itself; managing that cost is about the diagnosis itself.

AJMC: Your findings also highlight the potential value of earlier cancer detection in reducing both clinical and financial burdens. What role should Medicaid programs play in improving access to screening and timely diagnosis?

Kansal: There are 4 screening programs recommended by the US Preventive Services Task Force. Those are recommended with A or B ratings, which are lung cancer, breast cancer, colorectal cancer, and cervical cancer. There is a fifth, prostate cancer, which has a C rating, so that's individual decision-making. So, there are a significant number of cancers and important cancers with very strongly recommended screening technologies.

All of those cancers have a higher cost in our study when diagnosed at metastatic stages vs earlier. There's an obvious opportunity there to continue to support access to these screenings. There are a lot of programs to try to really support access to screening. Continuing to work with those populations to really enable their access is going to be important.

We also did, however, see important spending differences between cancers that don't have similar screening programs. We hope that the data can really inform policymakers as they consider some strategies to support timely diagnosis for those cancers, as well as when they think about the cost balance, the affordability of implementing new programs, and understanding the potential cost or spending differences that are associated with those metastatic diagnoses.

AJMC: As cancer therapies continue to advance, how can Medicaid programs balance access to innovative treatments with long-term cost sustainability? What strategies or policy approaches do you see as most promising?

Kansal: That's one of the key policy questions for Medicaid. Honestly, it's really one of the key policy questions for US health care as a whole. Screening, I think, is one of those strategies. I believe strongly in the benefits of screening and in early diagnosis and managing the burden of cancer. That cascades to the actual treatments themselves. When we find cancers earlier, the treatment paths are different, and so that can help minimize the requirement for some innovative therapies, which then facilitates access to innovative therapies for those who really need them.

Our study talks about the Medicaid program as a whole, although we describe the very specific states that are being considered; ultimately, Medicaid is administered at a state level. So, it's really 50 different programs, and the policies that are going to be most appropriate, the ways that each of those states is going to make innovative treatments available to their populations, it's really going to vary based on the priorities of each state and the means that are available.

I don't think there's a general answer to your question, I'm afraid, but it is a central question, and we hope that what our study is able to offer is data to show what the spending looks like today and what some of the opportunities might be. Then, as we think about how care will continue to evolve in the future, that can help shed light on what steps need to be taken and some opportunities where maybe early diagnosis can offer some benefits, some financial flexibility, and thus promote sustainability.

Medicaid is a very diverse program. There are a lot of components to this program, but one of the things that I think is most compelling is how much consistency there is in the types of care and the amount of care that patients require across the different states that we looked at. It really tells us that when we think about managing costs in Medicare, managing the spending, cancer, and, specifically, late-stage cancer, is going to be core.

One of the things that we're going to have to think about is how we manage diagnoses and how we address the number of patients who have late-stage diagnoses. Once they have the late-stage diagnosis, despite a very heterogeneous policy landscape across states, the spending and the utilization are there across all of those states. So, intervening earlier is one of the opportunities we might have to really make a difference.