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Article Abstract
Background: Colorectal cancer (CRC) screening is a HEDIS measure in value-based care (VBC), but the screening rate among patients in VBC is suboptimal.
Objective: To increase CRC screening through home-based fecal immunochemical test (FIT) among patients in VBC.
Design: Observational study.
Participants: We included patients aged 45-75 years in VBC (4 Medicare, 1 Medicaid plan) attributed to Northwell Health's provider panels who had not completed CRC screening for 2023 in October 2023.
Intervention: The primary exposure is mailed FITs to patients' homes from November to December 2023. Patients who had not completed the kits were reached through a series of three telephone calls 3 weeks after kits were delivered. For patients with abnormal results, we coordinated fast-track referrals to gastroenterology or colonoscopy.
Main Measures: The primary outcome of interest is the number and proportion of completed FIT kits. Our secondary outcome of interest is the Centers for Medicare & Medicaid Services STAR Quality Rating for each corresponding VBC plan.
Key Results: Out of 3680 kits mailed, 3466 (94.2%) kits were delivered. Among kits delivered, 465 (13.4%) kits were completed. We found that patients who had an appointment with providers within the last 18 months had a higher completion rate (15.9%) compared to patients who did not have a visit or had a visit more than 18 months ago (9.3%) (p-value < 0.0001). Among 45 patients with abnormal results (9.7%), 11 patients (24.4%) completed diagnostic colonoscopies and 10 patients (90.0%) were found to have tubular adenomas (May 2024). This initiative resulted in a 1 STAR increase across four value based care programs (2 Medicaid, 2 Medicare).
Conclusions: The population health initiative at scale to increase CRC screening resulted in a small, but meaningful improvement. There remain opportunities to improve CRC screening and treatment by coordinating diagnostic colonoscopies for this population.
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