New Hampshire Colorectal Cancer Screening Program Patient Navigation Model Replication Manual

The New Hampshire Colorectal Cancer Screening Program (NHCRCSP) patient navigation model has been highly effective in increasing the completion and quality of colonoscopy screening and surveillance among statewide underserved groups. Patients in this program, all of whom were navigated, were 11 times more likely to complete colonoscopy than non-navigated patients in a comparison group. Given this success, the Centers for Disease Control and Prevention (CDC) and the NHCRCSP worked together to develop a manual to help others replicate the model. The manual includes step-by-step instructions for implementing a screening navigation program, including a detailed navigation protocol, guidance on data collection, navigator training, and sample templates and tools.

Intended Audiences: Any organization that conducts colorectal cancer screening or administers a colonoscopy program may benefit from implementing this intervention. Organizations could include health systems, endoscopy centers, primary care practices (including Federally Qualified Health Centers), universities, state or local health departments, and grantee programs. This manual also may be useful for health care providers, pharmacy staff, and other community partners to clarify their roles in the intervention and how it benefits their patients.

Congratulations to former NCCRT Steering Committee member Dr. Lynn Butterly and to all the others who helped create this resource.

Evaluation: A rigorous evaluation was conducted, including a comparison of NHCRCSP-navigated patients to a similar group of non-navigated patients. Learn more on page 8 and in Appendix D. Evaluation results were also published in the journal Cancer.

Permissions: Made publicly available online through the Centers for Disease Control and Prevention.

Publication date: October 2016

Post date: September 18, 2017

Contact: Send comments, questions, and suggestions to NHPNManual@cdc.gov or NHCRCSP@hitchcock.org.

Study on Medicaid Expansion and Access

A study released by the American Cancer Society Cancer Action Network (ACS CAN) and the NCCRT estimates that in 2017 over 2.7 million low-income men and women aged 50-64 will remain uninsured and continue to lack access to an affordable health care coverage option, including colorectal cancer screening services.

The report, Health Reform and the Implications for Cancer Screening, provides national and state-specific estimates of the number of uninsured men and women in 2017 based on three scenarios: Medicaid expansion decisions as of April 2015, no state Medicaid expansions, and if all states expand Medicaid. Read the ACS CAN report summary.

Many thanks to our partners at ACS CAN for developing the report, and to NCCRT’s Policy Action Task Group members Barry Berger, Joel Brill, Heather Dacus and Holly Wolf for generously sharing their expertise in the review process.

The Importance of Waiving Cost-sharing for Follow-up Colonoscopies: Action Steps for Health Plans

The Affordable Care Act (ACA) eliminates cost-sharing for United States Preventive Services Task Force (USPSTF) – recommended preventative services for individuals who are privately insured, including screening for colorectal cancer by high sensitivity stool test or colonoscopy for adults ages 50 and 75.* Some health plans, however, apply cost-sharing to colonoscopies that follow a positive stool test. This creates a financial incentive for patients to select the more costly and invasive colonoscopy as their initial test. Additionally, this cost-sharing creates a financial disincentive that may lead patients to forego the follow-up test that they need.

This Issue Brief gives an overview of this issue and makes a request to health plans to waive cost-sharing for members when colonoscopy is ordered as follow-up to a positive stool test or other colorectal cancer screening test, just as cost-sharing is waived for colonoscopy when it is selected as the first-line screening exam.

Learn more in Colorectal Cancer Screening Best Practices Handbook for Health Plans, a compilation of best practices, case studies, templates and tools.

*The ACA preventive services requirements do not apply to “grandfathered” health plans that were in existence prior to March 23, 2010, as long as such plans continue to meet certain standards for grandfathered plans.

Coverage of Medicaid Preventive Services for Adults – A National Review

The NCCRT partnered with ACS CAN and the American Heart Association to commission researchers at George Washington University to determine state by state Medicaid coverage around USPSTF-recommended preventive services, including colorectal cancer screening.

While some research has been published examining Medicaid coverage of select preventive services, there has not been a comprehensive look at state-level Medicaid coverage of preventive services for adults. This study is intended to provide a better understanding of Medicaid coverage of preventive services for adults in the current state programs and inform state policy makers as they consider the level of preventive benefits and services to offer should they expand Medicaid in 2014.

The report was also the basis of a Health Affairs article that was published in July of 2013.  The article abstract can be accessed here.