Colorectal Cancer Screening Physician Orientation Stool DNA Testing for Colorectal Cancer Screening Physician Orientation Henry Ford EPIC Users October 2017 For More Information Visit: CologuardTest.com

Topics Scientific Overview Stool Collection Process EPIC Order Process HFHS Result Entry Process Reimbursement and Billing FAQs

*OC FIT-CHEK, Polymedco, Inc. Source: 1. AhlquistDA et al., Cancer (1989)

92% 94% 87% Cancer sensitivity Early stage cancer sensitivity NEJM published prospective study conducted across 90 sites1 92% Cancer sensitivity 94% Early stage cancer sensitivity 87% Specificity Head-to-head superiority to FIT* for cancer and precancer detection versus a leading fecal blood test (FIT) FIT is recommended annually and has a specificity of 95%; Cologuard is recommended every 3 years and has specificity of 87% Note: The performance of Cologuard has been established in a cross sectional study. Programmatic performance of Cologuard has not been studied. Performance has not been evaluated in adults who have been previously tested with Cologuard. Source: 1. Imperiale TF et al., N Engl J Med (2014) 5

Optical Colonscopy Range 94% - 97% Optical Colonscopy Range 94% - 97% Optical Colonoscopy Range 94% - 97% +PolymedcoOC-CHEK FIT. ImperialeTF et al. N EnglJ Med. 2014;370(14):1287-1297.

*If a result cannot be obtained due to insufficient sample size, low DNA capture, etc., the lab will automatically request a second sample, at no additional cost to the patient. ESL Patient Report. 2016.

Conducted by Exact Sciences Staff 67% Compliance* Cologuard’s patient compliance rate is derived from the number of completed tests reported divided by the number of collection kits shipped to patients during the 12-month period ending 60 days prior to December 31, 2016.

Ordering Cologuard in Epic

Ordering Cologuard in Epic

Ordering Cologuard in Epic

What happens when the Cologuard Order is Signed? An order is automatically faxed directly to Exact Sciences

What happens when the Cologuard Order is Signed? Cont. A Patient Instructions report is printed automatically and should be given to patient as a reminder

AVS SmartPhrase .COLOGUARD AVS when .COLOGUARD SmartPhrase is used

In Summary, 2 Items Should Be Given to Patient 1. AVS and 2. Cologuard Patient Instructions Automatic Note: provider will not receive notification directly in Epic Order faxed to Exact Sciences Automatic Patient should be given sheet before leaving office Patient Instructions sheet printed on clinic printer Provider Driven Patient should be given AVS before leaving office Use SmartPhrase to add Cologuard to AVS

Notification of Result Population Health Coder will retrieve the result from the Exact Sciences portal Result will be entered into Original Order and Updated to Final Result Quality Assurance protocols integrated into process A hardcopy of the result will be placed in the Media Tab Result will be sent to Provider’s InBasket in Epic Provider to assess whether patient is a MyChart user If yes, patient will automatically receive MyChart message with result If no, provider should utilize standard processes to ensure letter is sent to patient with result

Cologuard Satisfies Health Maintenance Cologuard Outcomes Cologuard Satisfies Health Maintenance Result sent to provider InBasket Patient notified through MyChart or by letter Repeat screening at appropriate interval Negative Provider orders Diagnostic Colonoscopy Positive Reason for cancellation sent to provider InBasket Cancelled result not posted in MyChart Provider takes appropriate actions (re-order or alternative screening method advised) Canceled Screening Interval Set at 3 Years Screening Interval Set at 3 Years Interval modified by Gastroenterology or PCP pending colonoscopy results Health Maintenance Not Met

$0.00 co-pay and $0.00 deductible Payor Coverage HAP – all members *effective 1/1/2017 $0.00 co-pay and $0.00 deductible Medicare FFS and MA BCBSM – PPO Vast majority have $0.00 co-pay and $0.00 deductible United HealthCare Aetna BCN Highly variable ($0.00 - $649.00) Note: All patients are advised to call their insurance provider directly to confirm potential out-of-pocket costs. The figures above are for informational purposes only and may not reflect current contract status.

FAQs Q. Does my patient really have to call their insurance company? A. Yes, all patients are advised to call their insurance company. While we believe most insurance companies in southeast Michigan provide coverage, we can not guarantee $0 co-pay and deductibles. Q. What happens if the order does not have one of the two z-codes (z12.11 and z12.22)? A. The Population Health Coder will be notified by Exact Sciences and will cancel the order and send an InBasket message to provider. Provider is asked to evaluate appropriate use of Cologuard and either 1) select alternative screening method or 2) re-order test with correct z-code(s) Q. What happens if my patient does not return the collection kit? A. Neither the patient or the insurance provider will be charged

FAQs Q. What happens if the test kit can not be processed; is there anything I need to do? Exact Sciences will reach out to your patient directly and explain why the kit could not be processed. They will ask permission to re-send the kit. If patient answers yes, the kit is re-shipped. If patient answers no, the order is cancelled. You will receive an InBasket message indicating a new screening method is advised. Q. Who bills for the Cologuard Test? Exact Sciences bills for the Cologuard test Q. Who should I contact with questions about the Epic Order? A. Open a helios helpdesk ticket and it will be routed appropriately. For administrative questions contact Emily Nerreter, Manager of Coding Quality and Education.