Increasing Access to Colorectal Cancer Screening

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Advocacy Blog
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A core part of Fight CRC’s advocacy mission is working to reduce barriers to colorectal cancer screening. To date, we’ve passed legislation at the federal level to eliminate surprise bills for Medicare patients who have polyps removed during a colonoscopy. We’ve worked to provide more funding for the CDC’s Colorectal Cancer Control Program, which works to increase screening rates in underserved communities. 

We’ve also helped to enact policy at the state level to ensure access to screening beginning at age 45 and to remove out-of-pocket costs for patients needing a colonoscopy after a positive noninvasive test. 

But in addition to state and federal advocacy, there are other levers that can help reduce barriers and increase access to screening. This year, through our Catalyst State-by-State Advocacy Program, Fight CRC was able to support the California Colorectal Cancer Coalition (C4) in their efforts to add colorectal cancer as a quality measure for the Centers for Medicare and Medicaid Services (CMS) Adult Core Set. 

We interviewed C4 President Daniel S. Anderson, MD, and Vice President, Margaret Hitchcock, PhD, to learn more. 

  • President, California Colorectal Cancer Coalition (C4)

  • Vice President, California Colorectal Cancer Coalition

Q. What are the CMS Medicaid Adult Core Set Quality Measures?

A. CMS is required by the Affordable Care Act to designate a core set of quality measures to help evaluate the quality of care received by individuals insured by Medicaid. (Note: Medicaid is a program funded by both states and the federal government and provides health coverage to low-income adults, children, and people with disabilities). 

All states are required to have quality measures that are reported annually by the Medicaid insurance carriers in each state. The states are not required to use the Medicaid Adult Core Set Quality Measures, but many use a portion or all of them. In 2019, California adopted the CMS Medicaid Adult Core Set Quality Measures for reporting in California, but at the time, breast cancer and cervical cancer screenings were the only cancer screening measures included. 

Q. Why is getting colorectal cancer screening added as a quality measure important? What impact will it have? 

A. Having colorectal cancer screening as a quality measure that has to be tracked and reported is one way to help increase screening rates. As the saying goes, “What gets measured gets improved” (NCQA). Only a handful of states measure Medicaid colorectal cancer screening rates, but those who do found that measuring colorectal cancer screening rates has helped to increase screening rates.

Medicare and Medicaid, combined, insured 18% of the United States population in 2019. In California, 33% of all Californians are on Medicaid due to the Medicaid expansion under the Affordable Care Act. Recent data has shown the COVID-19 pandemic has increased the United States Medicaid-insured population due to income loss and job loss. Having a colorectal cancer screening quality measure for this population will help ensure that more eligible individuals have access to this potentially lifesaving screening. 

Q. What was the process for getting colorectal cancer screening added as a quality measure for Medicaid?  

A. The CMS Medicaid Quality Measures are reviewed each year by 27 Core Set Review Voting Members who include experts representing diverse organizations from medical and dental societies, to public health, academic institutions, and insurance representatives. This group annually introduces, discusses, and votes on measures to be added or removed from the Medicaid Adult Core Set Quality Measures.

In fall 2020, C4 and our collaborators (Fight CRC, National Association of Chronic Disease Directors, and Leavitt Partners) were able to contact and enlist two of the Core Set Review Voting Members and persuade them to introduce colorectal cancer screening as a new measure to be added. C4 helped write the proposal and rationale for including CRC screening as a quality measure, and in May 2021, the proposal was introduced to the voting members and discussed during a session open to the public.  

The 27 voting members voted unanimously to recommend adopting colorectal cancer screening for the 2022 CMS Medicaid Adult Core Set Quality Measures and in December 2021, CMS officially accepted their recommendation! 

Q. How will this change help address health disparities? 

A. Unfortunately, only approximately 54% of Medicaid-insured adults are up to date on colorectal cancer screening compared to 80% of patients with Medicare and commercial insurance combined (NHIS data, 2018). Medicaid enrollees are also 50% more likely to present with late-stage colon cancer and die from it than those with commercial or Medicare insurance.  There are many reasons for these disparities, but ensuring that Medicaid plans are measuring colorectal cancer screening is one way to help incentivize providers to get their patients screened and ultimately decrease adverse outcomes from late-stage disease. 

Q. How can I make sure that this change is implemented in my state?

A. The first step is to contact your state’s Department of Health. Find out which agency administers your state’s Medicaid program, and contact the Chief of the Quality Division to inquire if they are using the CMS Medicaid Adult Core Set of Quality Measures. If they are, then your job is done! If they are not, ask for a list of the quality measures they are tracking to see if colorectal cancer screening is on the list. 

If your state is not tracking colorectal cancer screening, the Medicaid Quality Division in your state has a process to add and remove quality measures for your state’s Medicaid program. Find out what their process is to add new measures, and what you need to do to propose adding colorectal cancer screening. Since C4 successfully did this with CMS, we are happy to serve as a resource to help make this change in your state! 

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