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Transl Behav Med. 2020 Feb 3;10(1):68-77. doi: 10.1093/tbm/iby094.

Two Medicaid health plans' models and motivations for improving colorectal cancer screening rates.

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CareOregon, Inc., Quality Improvement, Portland, OR, USA.
Kaiser Permanente, Center for Health Research, Science Department, Portland, OR, USA.
Kaiser Permanente Washington Health Research Institute, Science Department, Seattle, WA, USA.
University of Washington, Department of Family Medicine, Seattle, WA, USA.


Screening rates for colorectal cancer (CRC) remain low, especially among certain populations. Mailed fecal immunochemical testing (FIT) outreach initiated by U.S. health plans could reach underserved individuals, while solving CRC screening data and implementation challenges faced by health clinics. We report the models and motivations of two health insurance plans implementing a mailed FIT program for age-eligible U.S. Medicaid and Medicare populations. One health plan operates in a single state with ~220,000 enrollees; the other operates in multiple states with ~2 million enrollees. We conducted in-depth qualitative interviews with key stakeholders and observed leadership and clinic staff planning during program development and implementation. Interviews were transcribed and coded using a content analysis approach; coded interview reports and meeting minutes were iteratively reviewed and summarized for themes. Between June and September 2016, nine participants were identified, and all agreed to the interview. Interviews revealed that organizational context was important to both organizations and helped shape program design. Both organizations were hoping this program would address barriers to their prior CRC screening improvement efforts and saw CRC screening as a priority. Despite similar motivations to participate in a mailed FIT intervention, contextual features of the health plans led them to develop distinct implementation models: a collaborative model using some health clinic staffing versus a centralized model operationalizing outreach primarily at the health plan. Data are not yet available on the models' effectiveness. Our findings might help inform the design of programs to deliver mailed FIT outreach.


Cancer screening; Direct-mail FIT outreach; Health plans; Implementation; Program design; Qualitative


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