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

Abstract

Background: Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now health insurance plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two health plans serving Medicaid and dual eligible Medicaid/Medicare enrollees.Methods: This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each health plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program planning meetings between the research team and the health plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the health plan interviews and develop summary themes through an iterative content analysis approach.Results: We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both health plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the health plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual health plan culture and needs, and the synchronicity between the programs and their organizational missions and goals. Conclusions: Both health plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by health plans, especially those serving Medicaid-and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations.

Screening for Colorectal Cancer Leading into a New Decade: The “Roaring ‘20s” for Epigenetic Biomarkers?

“…FIT testing is simpler and easier to perform, as it has no dietary or medication restrictions. Additionally, its overall precision for CRC detection is 95% with 79% sensitivity and 94% specificity, as previously shown [ 73 , 74 ]. Furthermore, it has greater sensitivity in detecting advanced adenomas and CRC when compared to gFOBT [ 75 ].…”

“…The fecal immunochemical test (FIT) uses antibodies that are specific for human hemoglobin, albumin, and other blood components such as globulin, and is more sensitive than the gFOBT test [ 71 , 72 , 73 ].…”

“…Most advanced adenomas (≥10 mm in diameter or with villous histologic features or high-grade dysplasia) are undetectable or poorly detected by examinations of fecal occult-blood tests. [ 69 , 73 , 76 ].…”

Health plan adaptations to a mailed outreach program for colorectal cancer screening among Medicaid and Medicare enrollees: the BeneFIT study

“…We conducted qualitative telephone interviews with the health plan leaders and staff who were involved in implementing the mailed FIT program after the first and second years of implementation. Analyses of year 1 interviews, exploring the successes and challenges of initial implementation, were published previously [ 16 ]. For the interviews following the second year, which focused on modifications to the program following initial implementation (the focus of the present analyses), we spoke with all staff at each health plan who were involved in second-year execution of the mailed FIT programs.…”

Health plan‐based mailed fecal testing for colorectal cancer screening among dual‐eligible Medicaid/Medicare enrollees: Outcomes of 2 program models

“…This study was part of BeneFIT, a collaboration between a research team and 2 health plans (called Health Plan Washington and Health Plan Oregon) for the purposes of implementing and evaluating a mailed FIT program. [9][10][11][12] The current analysis is limited to Health Plan Washington, the only health plan that changed its mailed FIT program model in the second year in which the program was conducted. Health Plan Washington operated in multiple states and included coverage for roughly 650,000 Medicaid and/or Medicare enrollees across Washington State.…”