Two Models for Improving Colorectal Cancer Screening Rates in Health Plan Populations

Authors:

Jennifer Coury, Care Oregon
Jennifer Schneider, Kaiser Permanente Northwest
Beverly Green, Kaiser Permanente Washington
Gloria Coronado (Presenter)
Kaiser Permanente Northwest

Laura-Mae Baldwin, University of Washington
Amanda Petrik, Kaiser Permanente Northwest
Malaika Schwartz, University of Washington

Public Health Statement: Weighing the successes and challenges in two models will help health plan decision makers choose between outreach strategies for colorectal cancer (CRC) screening.

Purpose: Screening decreases CRC incidence and mortality, however CRC screening rates remain low among racial/ethnic subgroups and low-income individuals. The BeneFIT study supports two Medicaid/Medicare health plans implementing a program that mails fecal immunochemical tests (FIT) to the homes of agea-eligible patients. Health plans can potentially manage the logistics and costs of mailing more easily than individual clinics or smaller systems.

Methods/Approach: FIT program models were based on implementation workflows developed by the health plans with input from the research team. In-depth qualitative baseline interviews were conducted with leaders from each health plan to learn about their organizations, prior CRC screening efforts, and reasons for implementing a mailed FIT program. Interviews occurred prior to implementation of the mailed FIT program, and were content analyzed for themes.

Results: The health plans are implementing the mailed FIT program using two distinct models: Collaborative and Centralized. Health Plan A, the Collaborative Model, has customized the mailed materials and process for each clinic system taking part in the program. They send the lists of enrollees due for screening to a print/mail vendor, who prints the materials, mails introduction letters, FIT kits, and reminder letters. Completed FITs are returned to the clinic, and the clinic staff place lab orders and send the FITs to the lab. Health Plan B, the Centralized model, has centralized all the activities. They send the lists of enrollees due for CRC screening to a vendor to print and send introduction letters, place lab orders, and mail the FITs. The vendor conducts reminder calls and reports back to the Health Plan. A central lab receives the completed FITs from enrollees and sends results to the vendor. The vendor notifies the provider to which the enrollee is assigned and the Health Plan that a FIT has been completed and sends the FIT test results. Health Plan B uses its care coordinators to follow-up on positive FITs.

Baseline qualitative interviews identified motivating factors for the health plans. The motivations to participate in a mailed FIT program were similar across the two organizations.

Conclusions/Implications: We present two models for Health Plan initiated, direct-mail fecal testing programs. Both models have advantages and disadvantages.