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Table 3 Implementation Successes Experienced in the First Year of BeneFIT

From: 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

Key Themes

Theme Identified by Health Plans

Sampling of Illustrative Quotes

Ā 

Collaborative Model

Centralized Model

Ā 

Program Design

ā€ƒFlexibility for each health plan to be either centralized or collaborative

X

X

ā€œ[Program] allows more people to be identified and screenedā€¦to really identify and get more people screened so we can move upstream any care that might be necessary for a member.ā€ ā€“ Centralized

ā€œA lot of other metrics to move are ones where patients need to come in for a clinic visit and so [we] particularly like this strategy because it can be done outside of the clinicā€¦and clinics were like, ā€˜we donā€™t have to do anything and youā€™re going to help us get more patients screened? Great! And clinics would sign on because the [mailing] effort was coordinated at [health plan].ā€ ā€“ Collaborative

ā€ƒAnother avenue to screen patients outside of a clinical visit/decreases patient burden

X

X

ā€ƒPartnership approach/design encouraged health center participation by reducing staff burden and cost to implement CRC screening on own

X

Ā 

ā€ƒHealth centers involved in project had all used FIT previously

X

Ā 

ā€ƒEncouraging health centers to scrub or clean eligibility list prior to mailing to update screening or identify wrong address

X

Ā 

Vendor Experience

ā€ƒDocumentation level from Vendor has been helpful

Ā 

X

ā€œWe had great success with follow-up calls to our members and getting them appointments for positive screenings and get them into the office ā€“ that worked well.ā€ ā€“ Centralized

ā€œWhat we learned with the ordering and processing of kits [with vendor] was a processā€¦like just getting the workflow of the kits sent here directly to [health plan], instead of kind of being the middleman and just shuffling things around, and that seems to be working pretty good now.ā€ ā€“ Collaborative

ā€ƒSuccess completing follow up calls and making appointments for members with abnormal result

Ā 

X

ā€ƒWorking through initial challenges to order and mail kits valuable

X

Ā 

Engagement and Communication

ā€ƒFamiliarity with health centers and strong relationships

X

Ā 

ā€œThe provider groups were informed well in advance on the project and were happy with the informationā€¦and another success is that we are getting more provider engagement around the intervention and understanding around what we are doing here in the quality department.ā€ ā€“ Centralized

ā€œ[Health centers] are invested in it, they are committed to itā€¦they spread it to their teams. They had meetings and explained the [program] ā€“ they knew what was happeningā€¦ we didnā€™t have any clinics take part that hadnā€™t already used FIT before in their clinics.ā€ ā€“ Collaborative

ā€ƒStaff at health centers knew what was happening regarding the program / and took work personally to work hard and achieve goal

X

Ā 

ā€ƒProvider groups and their teams were engaged and informed of program

Ā 

X

Reaction/Satisfaction of Stakeholders (provider /health center /patient)

ā€ƒPositive reactions from health centers and providers (e.g., no complaints)

X

X

ā€œMembers were very appreciativeā€¦We often donā€™t get a sense of member [satisfaction], but through this we were able to do a lot of member outreach after a possible positive result and actually speak to membersā€¦who were telling us about their experiences of screening.ā€ ā€“ Centralized

ā€œProviders are very grateful that this is just another way that we can tap into getting them in for screeningā€¦and the resources required at clinic level were so low ā€“ itā€™s when the FIT comes back in where most of clinic resources are and they already staff that generally ā€” so running the program at the clinic level was low enough that clinics werenā€™t saying they couldnā€™t staff it.ā€ ā€“ Collaborative

ā€ƒPositive reaction from patients (e.g., no complaints)/expressions of appreciation

X

X

ā€ƒSome patients called in to share they had their colonoscopy or FIT completed

X

X

ā€ƒPatients were appreciative of follow-up call after abnormal FIT result

Ā 

X

ā€ƒHealth centers that participated experienced minimum time and staff burden

X

Ā 

Processing/Returning of Mailed Kits

ā€ƒResults intriguing enough to continue program for second year

X

X

ā€œWe are really pleased to see how many of our Medicaid members that we included in the intervention actually complete a kit. Weā€™re usually very excited if we can get a very small percentage of our members to participate in an intervention that we target them forā€¦. And then with our Medicare population we had an [increase] of members complete the kits ā€“ so we are very excited about the outcomes that we did receive.ā€ ā€“ Centralized

ā€œWe are pleased with the partnership model showing successā€¦actively sending out kits to members through the BeneFIT program, you can actually see [clinic] numbers are incredibly higher. For some itā€™s almost doubled from what they were normally doing.ā€ ā€“ Collaborative

ā€ƒAct of trying it for the first year a success in and of itself: establish workflows and address challenges as move into second year

X

X

ā€ƒAccess to follow-up colonoscopy for abnormal results going well

X

X

ā€ƒMore members are being screened for CRC with mail out program than previously

X

X

ā€ƒReturn rates for Medicare and Medicaid members better than in past mailed efforts and seems promising

Ā 

X

ā€ƒCRC screening rates were higher in many health centers participating in program and improved from prior years

X

Ā 

Leadership Support

ā€ƒSupport and strong champion to lead program at health plan level

X

X

ā€œIt was helpful to have leadership buy-in from the beginning ā€“ to have [multiple health plan] leaders a part of the process early on and heavily involved at the very beginning ā€“ thatā€™s important for operating any large intervention.ā€ ā€“ Centralized

ā€œ[Health plan] has been sold on this project from the beginningā€¦and there is also medical collaboration too. Medical directors have been meeting with provider groups and giving presentations on the importance of FIT as a method of screening.ā€ ā€“ Collaborative

ā€ƒMedical directors at health centers promoting FIT and idea of mailed FIT

X

Ā 

Compatibility with Health Plan

ā€ƒMatches well with organizationā€™s mission and goals

X

X

ā€œFrom a program perspective I think it gets to what is needed and necessary for improving access to the tests and for more testing to be completed ā€“ so as a program it runs well.ā€ ā€“ Centralized

ā€œThis whole approach of collaborationā€¦is another big driving factor for thisā€¦ [Health plan] has a really strong ethos of working with clinics to help their patients get healthier and to push out preventive careā€¦[and] is known for working with their clinics in creative ways.ā€ ā€“ Collaborative

ā€ƒProject housed within group that measures how clinics/providers are doing on quality metrics, including CRC screening

X

X

ā€ƒOrganization known for working with their health centers in supportive and partnering ways

X

Ā 

Broader Impacts

ā€ƒProgram helps to increase patient engagement with their provider, the health plan, and their own health

X

X

ā€œIt really did invigorate our member outreachā€¦it has helped us with thinking about other outreach to members that might be successful.ā€ ā€“ Centralized

ā€œThis shows a path to improve colorectal cancer screening which is critical in and of itself. But importantly, what itā€™s saying is here is a model of how you can go about doing things ā€“ a model for expanding into other things outside of colorectal cancer screening.ā€ ā€“ Collaborative

ā€ƒIncreased general awareness of providers and other staff regarding activities in the health plansā€™ quality program departments, and specific awareness about mailed FIT programs

X

X

ā€ƒProvides a roadmap for addressing population health efforts via mail out programs for other care gap areas

X

X

Collaboration/Resources from Researchers

ā€ƒHelpful for health plans to learn from research staff, and learn how other plan is implementing the mailed FIT program (materials, design and delivery, etc.)

X

X

ā€œOne reason we like this so much is because there is a really important part of having [the researchers]and all the information and data thatā€™s being collected and presented to then inform beyond colorectal cancer screening.ā€ ā€“ Collaborative

ā€œThat partnership and seeing what others have done successfully in the field helped us improve our interventionā€¦and it was really nice to include the [wordless instructions] with the kitā€¦for those members who might have had a difficult time readingā€¦ā€ ā€“ Centralized

ā€ƒAbility to use wordless instructions developed by researchers for previous project

Ā 

X