Improving Colorectal cancer Screening: Promising Practices for State Medicaid Agencies

This report follows up on a 2015 report commissioned by the NCCRT, Colorectal Cancer Initiatives in Medicaid Agencies—A National Review. That report broadly described the activities being undertaken by Medicaid programs in all 50 states, identifying ten states that had adopted more robust approaches to colorectal cancer screening.

To develop a deeper understanding of how these higher-performing states are approaching the challenges of colorectal cancer screening, follow-up research was conducted with several of the states (Arizona, Maryland, Minnesota, Montana, New York, and Oregon) that had progressed further on their efforts. 

Thus, this guide establishes nine practices that have shown sufficient promise to merit consideration by other state Medicaid agencies who wish to enhance their screening efforts for this important population.

The 9 promising practices described within this guide include: 

  1. Define a CRC Metric for State Medicaid Plans
  2. Support or Mandate Public Reporting of CRC Screening Rates
  3. Develop an Incentive Program/Value-Based Purchasing Measure for CRC
  4. Provide Education and Technical Support to Managed Care Organizations and Providers
  5. Collaborate with State Public Health Staff
  6. Work Closely with FQHCs that Serve Large Medicaid Populations
  7. Promote Evidence-Based Strategies and Interventions
  8. Facilitate Access by Covering Multiple Tests Without Cost-Sharing
  9. Promote Test Options to Overcome Compliance Barriers, Provider Shortages, Geographic Issues, and Logistical Constraints

State-by-State Colorectal Cancer Screening Landscape

This resource, developed by Exact Sciences, provides a snapshot of the colorectal cancer screening landscape in each state while also putting into context how the different states compare with each other in a range of areas. While the majority of the information included is publicly available, it is difficult to find all this information in one place. This resource is intended to help people better understand what the CRC screening landscape – from coverage to screening rates to legislation – looks like in each state.

Evaluation: The last slide includes reference links for the included information. This involved considerable time and research across multiple websites and through research from Exact Sciences’ legal team.

Permissions: Made publicly available online by Exact Sciences.

Publication date: November 2019; updated August 2020

Post date: November 3, 2020

Contact: Submit comments, questions, and suggestions to Bryan Goettel: bgoettel@exactsciences.com.

80% in Every Community 2019 Messaging Guidebook: Recommended Messages to Reaching the Unscreened – July 16, 2019

This webinar provided an introduction to the 2019 80% in Every Community Messaging Guidebook: Recommended messages to reach the unscreened. The guidebook serves as a resource to both better understand the motivations, attitudes, and barriers of key unscreened populations, while it also recommends market tested messages that can educate and motivate these key audiences on the importance of colorectal cancer screening. The 2019 update to this NCCRT resource includes new findings, new population profiles, and message delivery insights that will better inform our efforts to improve colorectal cancer screening rates to 80% in Every Community. 

Speakers:

  • Michelle Aubertine, KS&R
  • Bill Willard, American Cancer Society

 

Colorectal Cancer Screening State Profiles

The Centers for Disease Control and Prevention’s (CDC’s) Colorectal Cancer Screening State Profiles provide state-specific colorectal cancer screening trends from 2012 through 2016, modeled county-level colorectal cancer screening estimates from 2014, and screening prevalence by race/ethnicity, sex, insurance status, and age group for all for all 50 states, DC, and Puerto Rico.

These profiles can help comprehensive cancer control programs, colorectal cancer control programs, and others with planning interventions and sharing current colorectal cancer screening estimates in their state.

Evaluation: Screening statistics come from CDC’s Behavioral Risk Factor Surveillance System, CDC’s National Center for Health Statistics, and other sources. View the footnotes of the state profiles to learn more.

Permissions: Made publicly available online by the Centers for Disease Control and Prevention, with content provided and maintained by the Division of Cancer Prevention and Control.

Publication date: November 14, 2018

Post date: December 6, 2018

Contact: Send comments, questions, and suggestions to ncccpcommunications@cdc.gov.

 

Colorectal Cancer Screening In American Indian & Alaska Native Communities – November 28, 2017

This webinar explored the opportunities and barriers related to delivering quality colorectal cancer screening and follow-up care in health care settings serving American Indian and Alaska Native (AI/AN) communities. The webinar provided a review of basic basic data on colorectal cancer incidence, mortality, and screening rates in AI/AN populations, an overview of the American Cancer Society and the NCCRT’s work to address this issue, and presentations from two AI/AN-serving healthcare systems about their innovative approaches to increasing colorectal cancer screening.

Learn more about the American Cancer Society and the NCCRT’s work to address this issue in the post-meeting report from the April 2016 one-day summit to explore the challenges and potential solutions to improving access to quality colorectal cancer screening in this population.

Speakers:

  • Kris Rhodes, MPH, Chief Executive Officer, American Indian Cancer Foundation (Moderator)
  • Laura Makaroff, DO, Senior Director, Cancer Control Intervention, American Cancer Society, Inc.
  • Jessica Deaton, RN, BSN, Care Manager, Oklahoma City Indian Clinic
  • Richard Mousseau, MS, Director, Community Health Prevention Programs, Great Plains Tribal Chairmen’s Health Board

Meeting Report: Increasing Colorectal Cancer Screening for American Indians and Alaska Natives

This post meeting report summarizes the presentations, discussions, and strategic planning that took place during the American Cancer Society and NCCRT co-sponsored meeting to discuss increasing colorectal cancer screening in American Indian and Alaska Native (AI/AN) communities that took place on April 25th, 2016 in Traverse City, Michigan. The report provides an overview of the burden of colorectal cancer among AI/AN, summarizes meeting presentations and discussions, and presents the participants’ collaborative “framework for change” tool that identifies goals, priority tactics, barriers, and potential communities of solution and roles.

Learn more by viewing the webinar replay and slide deck from the November 28, 2017 webinar that explored the opportunities and barriers related to delivering quality colorectal cancer screening and follow-up care in health care settings serving AI/AN communities.

elected officials

What Can Elected Officials Do To Advance 80% By 2018?

Learn how mayors, governors, and state legislators can be part of the national effort to make sure 80% of adults ages 50 and older are regularly screened for colorectal cancer by 2018.

Email Citseko.staples@cancer.org for a copy of ACS CAN’s 80% by 2018 documents for state or local policy makers.

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 Colonoscopy Under the Affordable Care Act’s Prevention Benefit

The Affordable Care Act (ACA) requires private health insurers to cover recommended preventive services such as colonoscopies without any patient cost-sharing. This 2012 report finds that confusion over whether colorectal cancer screenings are characterized as preventive care or treatment means patients sometimes receive unexpected bills for the procedure. The report examines cost-sharing practices for colorectal screenings through interviews with experts and officials in the medical and insurance industries.

This report was co-authored by The Kaiser Family Foundation, the American Cancer Society, and NCCRT.