Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Abstract

BACKGROUND: The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population. METHODS: Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized. RESULTS: In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region. CONCLUSIONS: Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.

Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities

“…No significant differences occurred among the groups, possibly because no FITs were provided and the incentive might have not been large enough to provide the added motivation needed to complete colonoscopy. 33 Our study found a nonsignificant trend toward fewer colonoscopies. Possible reasons are that individuals with sufficient intrinsic motivation to complete screening colonoscopy did not need incentives, some individuals were discouraged by possible additional charges, or some chose FIT when it was directly mailed to them.…”

Effectiveness and Cost of Implementing Evidence-Based Interventions to Increase Colorectal Cancer Screening Among an Underserved Population in Chicago

“…Cost data were also collected for the implementation phase from January 2016 to September 2017 to estimate costs of implementing the EBIs. To calculate the costs of activities, we tailored an existing cost data collection tool, which we have used in previous cost assessments, to reflect the activities being performed by Heartland (Dacus et al, 2018;Hoover et al, 2019;Kemper et al, 2018;Kim et al, 2018;Subramanian et al, 2018). Activities included contacting patients and monitoring and tracking their CRC screening status.…”

Addition of Financial Incentives to Mailed Outreach for Promoting Colorectal Cancer Screening

“…We excluded observational or nonrandomized studies and RCTs that compared different financial incentives without a usual care strategy, 17 reported long-term data of previously published trials, 18 or did not report specific CRC screening modalities. 19 …”

“…Studies that were included in the meta-analysis were RCTs that met the following criteria: (1) patients were adults older than 50 years who were eligible for or not up-to-date with CRC screening (not up-to-date was defined as not having had a colonoscopy in the past 10 years, flexible sigmoidoscopy in the past 5 years, or stool testing in the past year) according to prevailing guidelines, (2) patients either received interventions, such as various forms of financial incentives (fixed or lottery, which may be unconditional or conditional on screening completion) in addition to CRC screening reminders and/or mailed outreach, or they were assigned to a comparator group that received no financial incentives but received CRC screening reminders and/or mailed outreach, and (3) patients reported outcomes, such as CRC screening completion, by using recommended tests at different time points up to 12 months after intervention. We excluded observational or nonrandomized studies and RCTs that compared different financial incentives without a usual care strategy, reported long-term data of previously published trials, or did not report specific CRC screening modalities …”

“…We excluded observational or nonrandomized studies and RCTs that compared different financial incentives without a usual care strategy, 17 reported longterm data of previously published trials, 18 or did not report specific CRC screening modalities. 19 We searched PubMed, Cochrane Central Register of Controlled Trials, and Web of Science from inception to July 31, 2020, using keywords and Medical Subject Headings terms, including financial incentives, motivation, and behavioral economics in combination with cancer screening and colonoscopy. Two of us (A.F.…”