System-Wide Implementation of Colorectal Cancer Screening in a Value-Based Care Setting

Colorectal cancer (CRC) screening is a HEDIS measure in value-based care (VBC), but the screening rate among patients in VBC is suboptimal.

To increase CRC screening through home-based fecal immunochemical test (FIT) among patients in VBC.

Observational study.

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.

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.

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.

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).

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.