Colorectal Cancer Screening
Why is this important?
Nearly everyone should have a colon cancer screening beginning at age 50. High risk individuals and African Americans, American Indians and native Alaskans should be screened at an even younger age based on recommendations from their physician. When colon cancer is caught early, it is easier to treat. Screening can also prevent colon cancer from occurring by removing polyps before they become cancerous. A screening test can find cancer when there are no symptoms. HealthPartners looked at our data and saw that people on MSHO and people who don’t have a primary care clinic have lower screening rates than those with commercial insurance or are on Medicare.
What did we do?
The goal of this project was to increase the number of people who are up to date on colon cancer screening. We targeted all MSHO and Medicare members who were overdue or had never had a colon cancer screening and commercial members who did not have a primary care medical provider. We also partnered with care systems to support their efforts to screen their patients.
Many people don’t realize that there are options for cancer screening and avoid traditional colonoscopy because of fear and embarrassment. We used letters and phone calls to educate people about all their options.
We looked at our data and identified members who were due for a colon cancer screening.
- We sent them a letter telling them we would send them a Fecal immunochemical test (FIT) colon cancer screening test that they could do at home and send back.
- HealthPartners worked with a biometric screening vendor to send FIT kits directly to member homes.
- Test results were sent to the member and to their primary care doctor (if we knew it).
- All positive tests were followed up by a nurse with a letter and/or a phone call.
What challenges did we face?
Some people who were not familiar with the FIT test did not understand how to complete the test. The nurses managing the project did a lot of phone education to these members who called with questions.
Not every organization agrees on when colorectal cancer screening should begin. It can be confusing for people to know when to start screening and how often to get screened.
Although we communicated with clinics through our provider newsletter, the information about the outreach project often did not filter down to individual clinicians. Doctors prefer to be more involved with information their patients receive.
The COVID-19 pandemic and civil unrest that occurred during 2020 became a barrier for members to access care. Shelter in place order impacted care in several areas. Travel restrictions made it challenging to get to appointments especially when public transportation was limited and fear of exposure to the virus for those who had to use public transportation. The UPS had delays in sending letters and test kits. The lag time for some areas increased by several days making timely action more difficult in some cases causing test to be repeated.
Results
In 2020, we sent a total of 19,201 FIT kits to our members. Of those, 252 FIT kits were sent to MSHO members. Of those, 65 (26%) did not have a primary care provider.
Over the course of the this project, HEDIS rates (the way we measure completion of a colon cancer screening) have continued to increase, showing that this outreach directly to members is effective in encouraging people to get screened for colorectal cancer. However 2020 a decrease in rates was seen. The COVID-19 pandemic and civil unrest that occurred during 2020 became a barrier for members to access care. Shelter in place order impacted care in several areas. Travel restrictions made it challenging to get to appointments especially when public transportation was limited and fear of exposure to the virus for those who had to use public transportation. The UPS had delays in sending letters and test kits. The lag time for some areas increased by several days making timely action more difficult in some cases causing test to be repeated.
2017 |
2018 |
2019 |
2020 |
|
|---|---|---|---|---|
| HEDIS Measures | ||||
| 69.2% | 69.3% | 78.0% | 70.3% | |
| 82.8% | 82.2% | 86.4% | 77.1% | |
| MSHO | 66.6% | 72.3% | 76.4% | 66.2% |
Ongoing work
HealthPartners feels that home test kits are an effective way to encourage members to get screened for colon cancer and will continue this project in 2021.