The National Committee for Quality Assurance (NCQA) has released a new Healthcare Effectiveness Data and Information Set (HEDIS) quality measure that, for the first time, holds health plans accountable for whether patients get a follow up colonoscopy after an abnormal noninvasive screening test. It is a meaningful step toward ensuring patients have access to the complete screening process, a longtime goal of Fight CRC. Here is what happened, why it matters, and what advocates can do next.
The Gap: Follow-Up Colonoscopy Completion After a Non-Invasive Screening Test
The colorectal cancer screening space has advanced rapidly over the last decade with many new non-invasive screening options available to patients. These non-invasive tests have provided more options, allowing patients the ability to screen for CRC in the way that best fits their needs, but noninvasive tests are only effective screening tools when abnormal results are followed by a colonoscopy. A positive result cannot confirm or rule out cancer on its own. It is the follow up colonoscopy that determines what that result means, and, when needed, removes precancerous polyps before they become cancer.
Too many patients never take that next step or are forced to wait far too long to get a colonoscopy scheduled, and the consequences of these delays and incomplete screenings are significant. Patients who don’t complete a follow-up colonoscopy after an abnormal noninvasive test face twice the risk of dying from colorectal cancer as those who do.
Research also shows that the length of the wait itself matters: patients who did not receive a follow up colonoscopy until more than a year after a positive test faced more than double the risk of a colorectal cancer diagnosis, and more than triple the risk of being diagnosed at an advanced stage, compared with patients who were seen within a month. As screening options expand, so does the need to make sure every positive result leads to the follow-up care that makes screening worth doing in the first place.
What is a quality measure, and how does it help close the gap?
Health insurance plans are scored not just on cost, but on how well they actually deliver good care. Quality measures are the specific, standardized benchmarks used to track, things like whether patients get recommended screenings, whether chronic conditions are managed well, and whether necessary follow up care happens on time. If a measure exists for something, health plans must track it, report it, and improve their performance on it. If no measure exists, that gap in care can go on indefinitely with little accountability.
What is HEDIS?
HEDIS is the most widely used set of quality measures in the country. HEDIS measures apply to commercial health plans, Medicare Advantage plans, and Medicaid plans. Health plans report their HEDIS scores publicly, and employers and regulators use them to evaluate plan performance, and in some cases, they affect a plan’s funding and ratings. In short, HEDIS is how the health care system keeps score on care quality.
HEDIS has tracked colorectal cancer screening for years, scoring health plans on whether eligible patients complete a screening test in the first place. What it has never tracked, until now, is what happens after a non-invasive screening test comes back abnormal. A health plan could score well on getting patients screened while having no accountability for whether those patients ever got the follow up colonoscopy they needed. This gap is exactly what the new measure moves towards closing.
Why Measures Matter
There is a simple principle behind why this is a meaningful development: what gets measured gets done. Health plans invest time, staff, and systems into the things they are scored on, because their performance on those measures is public, and in many cases tied to funding and reputation. For years, follow up colonoscopy after an abnormal test fell into a blind spot. Without a standard measure or form of consistent accountability built into the healthcare system, too many patients have been left behind. Now that a measure exists, follow up completion becomes something health plans have to actively manage and improve, not something that can quietly slip through the cracks.
Fight CRC and the follow-up colonoscopy
Fight CRC engaged directly in the process that shaped this measure. A Fight CRC representative participated in NCQA’s Cancer Measurement Advisory Panel, a multi-stakeholder group of clinicians, scientists, and patient advocates that guides the development of oncology quality measures, and Fight CRC also submitted formal comments on the proposed measure during the public comment period.
But even before this process began, Fight CRC has long been sounding the alarm about the importance of the follow-up colonoscopy after an abnormal non-invasive colorectal cancer screening test. We helped pass legislation in 11 states and worked with our advocacy partners to secure guidance from the federal government and to ensure no-cost access to the follow-up colonoscopy.
In 2024, Fight CRC launched the Colorectal Cancer Care Initiative (CRCCI), a collaborative effort grounded in real world data that sets out practical yet ambitious goals to enhance colorectal cancer screening and care across the country. The CRCCI set two concrete goals, with associated targets, for what colorectal cancer care in this country should look like, including a goal that speaks directly to this problem: 80% of patients with an abnormal noninvasive test should receive a follow up colonoscopy within 90 days.
We anchored on this target because our analysis of billions of health insurance claims from across the country showed a precipitous drop off in those completing a follow-up colonoscopy after 90 days and “eventually” is not good enough when someone is waiting to find out whether they have cancer.
Opportunities to Strengthen the Measure
This measure is a step in the right direction, but it falls short of CRCCI’s goal in two very important ways.
The first is timing. The CRCCI calls for 80% of patients with an abnormal noninvasive test to receive a follow up colonoscopy within 90 days, but this measure allows plans to score well even when patients wait twice that long, up to 180 days, before getting scheduled. A patient whose colonoscopy happens on day 179 still counts as compliant, even though every additional week of delay carries added risk.
The second is scope. This measure only tracks follow up after a stool-based test, even though blood-based colorectal cancer screening tests are now FDA approved and covered by many insurers, including Medicare. A measure built around one pathway is already behind where screening is headed, and it leaves a growing share of patients with no accountability at all for their follow up care.
This measure is far from perfect, but it represents real progress in building accountability where none has existed before. We strongly encourage NCQA to tighten the follow up window toward 90 days and expand the measure to cover every noninvasive test type in future measurement years.
Closing the Gap for Good
This measure is built into HEDIS Measurement Year 2027, meaning health plans begin tracking and reporting on it starting January 1, 2027.
Closing this gap for good will take more than a single quality measure. It will take stakeholders from across the health care space working together to push for accountability, creatively tackle challenges, and strive towards aspirational goals. That is exactly what CRCCI invites health systems, advocacy organizations, industry partners, physicians, and others to do. Joining CRCCI means committing to measure your own performance against two evidence-based goals and associated targets, including timely follow up after an abnormal test, and working alongside a growing network of organizations already pushing the entire field toward better, faster, more equitable colorectal cancer care.