Direct‐to‐member mailed colorectal cancer screening outreach for Medicaid and Medicare enrollees: Implementation and effectiveness outcomes from the BeneFIT study

Abstract

BACKGROUND:Colorectal cancer screening uptake is low, particularly among individuals enrolled in Medicaid. To the authors' knowledge, little is known regarding the effectiveness of direct-to-member outreach by Medicaid health insurance plans to raise colorectal cancer screening use, nor how best to deliver such outreach. METHODS: BeneFIT is a hybrid implementation-effectiveness study of 2 program models that health plans developed for a mailed fecal immunochemical test (FIT) intervention. The programs differed with regard to whether they used a centralized approach (Health Plan Washington) or collaborated with health centers (Health Plan Oregon). The primary implementation outcome of the current study was the percentage of eligible enrollees to whom the plans delivered each intervention component. The primary effectiveness outcome was the rate of FIT completion within 6 months of mailing of the introductory letter. RESULTS: The health plans identified 12,000 eligible enrollees (8551 in Health Plan Washington and 3449 in Health Plan Oregon). Health Plan Washington mailed an introductory letter and FIT kit to 8551 enrollees (100%) and delivered a reminder call to 839 (10.3% of the 8132 attempted). Health Plan Oregon mailed an introductory letter, and a letter and FIT kit plus a reminder postcard to 2812 enrollees (81.5%) and 2650 enrollees (76.8%), respectively. FIT completion rates were 18.2% (1557 of 8551 enrollees) in Health Plan Washington. In Health Plan Oregon, completion rates were 17.4% (488 of 2812 enrollees) among enrollees who were mailed an introductory letter and 18.3% (484 of 2650 enrollees) among enrollees who also were mailed a FIT kit plus reminder postcard. CONCLUSIONS: The implementation of mailed FIT outreach by health plans may be effective and could reach many individuals at risk of developing colorectal cancer. Cancer 2020;126:540-548.

First-year implementation of mailed FIT colorectal cancer screening programs in two Medicaid/Medicare health insurance plans: qualitative learnings from health plan quality improvement staff and leaders

“…This qualitative descriptive study was embedded within the larger BeneFIT hybrid implementation-effectiveness study [14]. For the BeneFIT study overall, our research team recruited two health plans, one in Oregon and one in Washington state, willing to design and implement programs geared towards mailing FIT kits to the addresses of age-eligible health plan members overdue for CRC screening.…”

What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

“…The research team has previously reported on the BeneFIT program's effectiveness in the research sample of six of the larger health systems and found that 20.6% of those who were mailed an introductory letter, FIT, and reminder postcard completed CRC screening. 24 However, FIT completion rates varied greatly (from 10.0-21.1%) across the health systems in that research study. 24 A similar mailed FIT intervention in a pragmatic trial (STOP CRC) also showed improved screening rates with substantial variation between health systems.…”

“…24 However, FIT completion rates varied greatly (from 10.0-21.1%) across the health systems in that research study. 24 A similar mailed FIT intervention in a pragmatic trial (STOP CRC) also showed improved screening rates with substantial variation between health systems. 25 The BeneFIT mailed outreach program was exible and allowed each health system to decide their organizational practices to adapt the central program for their health system work ows.…”

“…Phone call reminders appeared in multiple solutions, consistent with ndings from other studies. 24 Systems that added phone calls in Year 2, instituted a 12month visit requirement in Year 2, or had been in prior research studies achieved higher screening rates in Year 2 over Year 1, indicating a focus on speci c process improvements can lead to success.…”

“…Six health systems were in the research study sample (outcomes previously reported) because they had the capacity to provide FIT test results and implement the program quickly enough for research purposes. 24 An additional 11 health systems implemented BeneFIT in the rst two years that the health insurance plan offered the program. We report here on implementation variations (i.e., adaptations) and response rates for all 17 health systems that took part in the BeneFIT program offered by the Oregon health insurance plan.…”