Breast Cancer Screening

Why is this important?

Breast cancer screening, or mammograms, can detect breast cancer in very early stages, when treatment could be less invasive and more successful. Women should begin to talk to their doctor about mammograms in their 40s and should have their first mammogram by the time they are 50 years old. HealthPartners looked at our data and saw that people on MSHO have lower screening rates than those with commercial insurance or are on Medicare.

Local research by the Breast Cancer Gaps project indicates that many women, especially women of color, delay getting their mammograms because of emotional factors, including fear. Fear was a recurring theme for the women including fear of cancer itself, fear of feeling sick, and fear that the cancer treatment would be worse than the cancer itself. Family history of breast cancer also increased women’s fears.

The Breast Cancer Gaps project asked women where they get information about breast health information. Responses indicate:

• Doctor or nurse (88.5%)
• Community organizations (52.1%)
• Friends and family (46.9%)
• Social media (29.2%).

The survey also showed that women most commonly talk about breast health with friends (60%), siblings (37%), and spouse (37%).

Based on this information, HealthPartners decided that a personal approach was important to educate and encourage women to get this important screening.

What did we do?

The goal of this project was to increase the number of MSHO members who are up to date on breast cancer screening. We targeted all MSHO members who were overdue or had never had a breast cancer screening.

In partnership with a local Community Health Worker (CHW) organization, HealthPartners implemented targeted outreach to our diverse MSHO membership to encourage them to receive breast cancer screening. Even for people who do not have a language barrier, engaging with the health care system can be intimidating. CHW support helped break down barriers to care for these members.

• As trusted members of the community, CHW Solutions staff contacted our members to remind them of important cancer screenings.
• CHWs contacted members in their native language when possible and utilized interpreters when needed. Languages included in the outreach list included English, Spanish, Hmong, Karen, Oromo, Russian, Romanian, Somali, Swahili and Vietnamese. Of the 163 members identified, CHW Solutions was able to engage with 83 members, for a 51% engagement rate (61% if bad phone numbers are removed from the total). Members widely reported appreciating the outreach.
• Friends and family (46.9%)
• Members who spoke English accepted help scheduling an appointment at a rate of 21% and those who spoke a language other than English accept assistance making an appointment 17% of the time.

In addition to the CHW phone outreach, we updated our educational breast cancer screening outreach to be more personalized and translated it into several languages.

• Messages were sent to members who had not had a mammogram in the past 12 months. HealthPartners sent the messages by email if it was on file, into their web account, and by US mail.
• We translated messages into Spanish, Somali and Vietnamese and communicated with our members using their preferred language preference. If no language is on file, we send information in English.
• To promote screening, we send reminder emails every 3 months to members who do not have a primary care provider (PCP) and every 6 months to members who do have a PCP

What challenges did we face?

As indicated earlier, some members have a very emotional reaction to the idea of mammograms. Fear of the procedure itself and fear of the results are very real factors in member resistance to the screening.

Cultural factors play into acceptance of breast cancer screening recommendations. In some cultures, preventive care is not common. If people, had a negative experience with the health care system, they are understandably reluctant to seek care.

For MSHO members, lack of a current, valid phone number makes phone outreach challenging. Often, the number in our records is an adult caregiver who is being asked to relay the information to the member. For others, the phone number is not in-service.

Only half of MSHO members have a web account with the health plan or our care group, so communication must be via US Mail or phone call if the member hasn’t established an account.

Many clinic systems are still experiencing staffing shortages and other impacts from the Covid-19 pandemic. Radiology is one of the areas heavily impacted by these shortages, often making it difficult to make an appointment for a mammogram. Many locations discontinued walk-in screening availability for this reason as well.

Results

Between 2021 and 2022, HealthPartners saw a 2 percent increase in breast cancer screening rates for our MSHO members.

To measure the impact of the CHW outreach, we tracked how many members the CHWs contacted (over 50%) and also how many members received their mammogram after they talked with the CHW. Table 2 shows conversion rates by race and language. A ‘conversion’ means that the member received a mammogram after being contacted by a CHW. Based on our internal analysis, his outreach resulted in a 3.3% improvement in our screening rate.

To evaluate the effectiveness of the email and US mail campaign, we analyze how many members get a mammogram after receiving our message. Members who received and read the email message were much more likely to subsequently get their mammogram than members who did not read the email.

Table 4 shows the conversions by language. The number of Vietnamese and Somali members who received the emails was very small. Spanish-speaking members were more likely to get screened after receiving our message compared to those who did not open the message. The mail campaign was equally productive for English and Spanish speakers. Although the numbers are small in the Vietnamese and Somali group, these are members that potentially would not receive the message anywhere else, so we feel this is an important result.

Ongoing work

HealthPartners feels that both digital and postal outreach campaigns are successful and will continue to utilize both as much as possible.

• The mammogram email and mail campaigns are ongoing and.
• Using CHWs to engage and educate members is a valuable strategy and we will continue to utilize this approach as resources allow.