1. 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

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

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

5. 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

6. 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):

7. *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

12. 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.

13. Ordering Cologuard in Epic

14. Ordering Cologuard in Epic

15. Ordering Cologuard in Epic

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

17. 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

18. AVS SmartPhrase .COLOGUARD
AVS when .COLOGUARD SmartPhrase is used

19. 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

20. 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

21. 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

24. $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 $0.00 deductible
United HealthCare
Aetna
BCN
Highly variable ($ $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.

25. 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

26. 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.