ASPO Abstracts
A claims analysis of colorectal cancer screening initiation among Medicaid enrollees who received a mailed screening intervention
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Purpose: This analysis assessed colorectal cancer (CRC) screening patterns in a population
of Medicaid enrollees not current with screening who received a mailed fecal
immunochemical test (FIT)-based intervention.
Methods: In a randomized controlled trial carried out in partnership with a county health
department, 2,144 average-risk North Carolina Medicaid enrollees ages 52 to 64 who were
due for CRC screening were randomized to receive one of two mailed FIT interventions. The
interventions included a mailed reminder letter notifying them that they were due for
screening and providing instructions on how to obtain a FIT kit (Reminder Only) and a
mailed reminder plus FIT kit (Reminder+FIT). For this analysis, we obtained Medicaid claims
data for these enrollees from October 2016 to August 2018, comprising the trial period and
18 months of follow-up from the initial mailing dates. We determined the proportion of
individuals who completed FIT screening within 12 months of receiving the intervention. In
addition, we identified other non-FIT modalities of CRC screening within 6 months of the
initial invitation.
Results: Of the 2,144 enrollees, 458 (21.4%) had at least one claim related to CRC
screening between October 2016 and August 2018, of whom 411 (89.7%) had a valid
address. These 411 enrollees included 229 (55.7%) who received the Reminder+FIT and
182 (44.3%) who received the Reminder Only. Among the 411 individuals with claims data
available, 356 (141 in the Reminder+FIT group and 74 in the Reminder Only group)
completed a study FIT within 12 months. The interventions also were associated with 50
additional screenings within 6 months by modalities other than FIT. Of these 50 screenings,
32 (64%) were in the Reminder Only group, including 25 colonoscopies, 6 non-study stool
tests, and 1 barium enema, and 18 (36%) were in the Reminder+FIT group, including 15
colonoscopies and 3 non-study stool tests.
Conclusions: Both mailed FIT interventions were associated with improved CRC screening
in a Medicaid population known to have relatively low screening compared to other insured
populations. The Reminder+FIT initiated higher screening rates overall and specifically by
FIT, whereas the Reminder Only was associated with more CRC testing through other
modalities.
Keywords: colorectal cancer screening, claims, Medicaid