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In an era where testing for colorectal cancer (CRC) is becoming more accessible, and where there is more knowledge about the importance of screenings than ever before, why are there still significant gaps in utilization of fecal immunochemical tests (FIT)? That’s an important question for health plans to answer as some 45 percent of the population still don’t get screened for CRC, leading to significant gaps in care and missed opportunities for better outcomes.

Low health risks are integral to good health and employer-sponsored programs are an effective way to help individuals reduce their health risks. A study from NCBI provides evidence that wellness program participation was associated with significant risk reduction, particularly among people who participated in more than one program. The study looked at almost 200,000 wellness program participants and showed that 5 of 7 health risks (blood pressure, body weight, cholesterol level, nutrition, physical inactivity, stress and tobacco use) improved after one year.

A single FIT test detects about 73 percent of CRC and helps physicians better target those patients at higher risk

Addressing Myths

At its most basic level, the reason people don’t participate in screening programs comes down to myths and misperceptions. Even in populations with coverage, many still don’t understand the dangers of CRC, the risks, and more importantly how easy today’s testing can be.

*In 2016, the American Cancer Society (ACS) conducted a survey of 2,000 individuals and found out the top reasons people don’t get screened. They include:

They are too embarrassed to discuss colorectal cancer screening with their doctor.

They have no family history, and therefore think they aren’t at risk and don’t have to be screened. (Major groups like the ACS recommend screening for all individuals at average risk.)

They think screening is only for those who have symptoms. (Screening should be done even without symptoms.)

Finally, and perhaps most importantly, many people are concerned about the complexity and costs of screening, including transportation to and from the doctor’s office and high out-of-pocket expenses.

*American Cancer Society.

Filling in the Gaps

Forward-thinking health plans are taking steps to address common CRC myths and close gaps in care, especially for the population that needs it most – Medicare beneficiaries. These steps are important because gaps in testing lead to higher costs, increased rates of CRC, and most importantly, plan members at risk for a potentially deadly disease. Conversely, early detection lowers the cost of care, with treatment of the later stage of the disease four times as expensive as that for earlier stages of the disease in the first year alone (Fitch et al. Am J Managed Care).

One Plan’s Experience

Late last year, a large southeastern regional health plan took up the gauntlet against gaps in care. At the beginning of December, the health plan came to BioIQ with a major dilemma. Unexpectedly, they discovered that a significant percentage of their 8,600 Medicare Advantage members would count toward their quality ratings in 2018. BioIQ was brought in to bring its experience, analytics and proven results to ensure the plan helped these members, kept its 4-star rating and that it gained an edge in a highly competitive market.

One of the first steps they took was to meet with BioIQ’s experienced team leaders to identify what solutions would be best for their population health and gap closure initiatives. Per BioIQ’s recommendation, the plan embarked on a zero-cost, at-home CRC testing program for members. It was the right choice as FIT tests are non-invasive and detect occult blood, which is the number one early indicator of CRC. The approach was also a smart move for the health plan, as screening for colon cancer with FIT testing results in a 32 percent reduction in colon cancer mortality (USPSTF JAMA 2016).

CRC testing wasn’t new to the health plan, or its members, but there had been problems
with past initiatives. Health plan leadership reported that member non-compliance
was a primary concern. Members often declined to participate, citing many
of the same issues as outlined by the ACS (e.g., embarrassed) and that testing was
inconvenient or inaccessible. Additionally, many members were not aware their plan
covered CRC screening.

Forward-thinking health plans are taking steps to address common CRC myths and close gaps in care

Meeting the Member Where They Are

BioIQ was able to quickly ramp up an engaging and targeted FIT testing initiative for the plan’s Medicare Advantage members. Due to its personalized outreach and engaging communications, all backed by a strategic and scientific approach to engagement, BioIQ was able to achieve a 34% return rate for the targeted members. The rate of return is two-and-a-half times higher than that of many reported industry experiences. Equally impressive as the results were that they were achieved in less than one month – just what the health plan needed to achieve its goals by the end of the year.

Members appreciated the outreach and convenience of the FIT test. It was simple, private, convenient and free. The test could be completed at home in about five minutes, eliminating hours of lost productivity associated with preparing for and recovering from a colonoscopy. Medicines and food do not interfere with the test, so it tends to be more accurate and have fewer false positive results than other tests. All of this adds up to a much more appealing alternative that ultimately helped the plan encourage more members to get screened. Members weren’t the only ones happy.

“We are pleased and excited at the return rate for the FIT kits,” noted health plan leadership. “Even with a rushed implementation, BioIQ was able to achieve a high return rate for the plan’s population. We know the simplicity and convenience of the FIT test is what enabled us to achieve our goals, even within a population that is often difficult to reach.”

The plan leadership noted that the follow-up contact from BioIQ was one of the best features of the program. Several members who did not initially return a kit did so after receiving outreach either by phone, email or text. Such efforts are part of a well-thought-out strategy for BioIQ. To determine the best approach for screening programs, BioIQ leverages analytics-fueled insights to deliver an experience tailored to the individual that results in maximum participation.

The health plan was also excited about the overall member engagement generated and the possibilities of what it could lead to in the future, including:

Saved lives – for every ~1,100 people screened for CRC, a life is saved (FIT testing has been proven to lead to earlier detection, resulting in lower mortality).

Improved Star Ratings and impact on HEDIS measures.

Increased member enrollment due to community recognition that the plan is high-performing and exceptionally committed to members.

Enhanced marketing opportunities for the plan as a result of the program’s success.

Finding ways to close gaps in care is a critical need for health plans today. A single FIT test detects about 73 percent of CRC and helps physicians better target those patients at higher risk. Savings for health plans are also significant, with the average FIT test costing 10-times or more less than that of a traditional colonoscopy.

While important, such savings don’t begin to cover the benefits of a program that closes gaps in care, improves member engagement and helps to prevent a costly and devastating disease.

To learn more about how BioIQ can help your organization close gaps in care, please call 888-818-1594 or email