Challenges in Reaching Medicaid and Medicare Enrollees in a Mailed Fecal Immunochemical Test Program

• Published in: Journal of community health Vol. 45; no. 5; pp. 916 - 921
• Main Authors: Green, Beverly B., West, Imara I., Baldwin, Laura Mae, Schwartz, Malaika R., Coury, Jennifer, Coronado, Gloria D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2020; Springer Nature B.V
• Subjects: Age; Aged; Ambulatory Care Facilities; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Community and Environmental Psychology; Demonstration Programs; Early Detection of Cancer; Ethics; Feces; Female; Government programs; Health care; Health care facilities; Health insurance; Health Promotion and Disease Prevention; Humans; Insurance; Male; Medicaid; Medicare; Medicine; Medicine & Public Health; Middle Aged; Motivation; Occult Blood; Original Paper; Postal Service; Subgroups; United States; United States; Screening; Fecal tests; Mailed; Medicaid; Colorectal cancer
• ISSN: 0094-5145; 1573-3610; 1573-3610
• DOI: 10.1007/s10900-020-00809-9

BeneFIT was a demonstration project that worked with a Medicaid/Medicare health plan to implement a mailed fecal immunochemical test (FIT) program. The goal was to reach age-eligible enrollees who were due for colorectal cancer (CRC) screening and prompt them to complete a FIT. One health insurance plan collaborated with six federally qualified health centers (FQHCs) in Oregon. Reach was defined as the percent of eligible individuals overdue for CRC screening who were mailed a FIT in 2016. We examined patient-level factors associated with reach, using multivariable log binomial regression and FIT completion rates at 6 months. The health plan identified 3386 age-eligible members overdue for CRC screening. Of these, 2615 (77.2%) were reached (mailed FIT kits) and 771 (22.8%) were not; 478 (14.1%) because they were not considered to be clinic patients and 290 (8.6%) because of mailing issues. Patient-level factors associated with not being reached were: being male, being Medicaid-insured (vs. Medicare), and having no primary care visits (vs. 4+ visits) in the last year. Among all enrollees identified as overdue for CRC screening, FIT completion rates at 6 months were 14.8% overall and 18.5% in the subgroup reached. In a mailed FIT program, a health insurance plan attempted to reach as many enrollees overdue for CRC screening as possible, however 22.8% were not mailed a FIT. Additional efforts are needed to ensure that the hardest to reach enrollees can participate in CRC screening.