1. BeneFIT SIP:
A Pilot Program of Mailed FIT Tests to Increase Colorectal Cancer Screening Rates in Medicaid / Medicare health plans

2. What is BeneFIT?
A 4-year SIP grant funded by the Centers for Disease Control in September 2015 to the Health Promotion Research Center at the University of Washington
BeneFIT co-PIs:
Laura-Mae Baldwin (University of Washington)
Gloria Coronado (Kaiser Permanente Center for Health Research)
Beverly Green (Kaiser Permanente WA)
BeneFIT CDC collaborator: Jean Shapiro

3. BeneFIT
Collaborative program with two Medicaid/Medicare health plans to implement and evaluate mailed fecal test (FIT) outreach
Overall goal is to improve colorectal cancer screening rates among health plan enrollees

4. BeneFIT addresses low screening rates in Medicaid populations
Colorectal cancer screening rates are low among Medicaid enrollees:
Nationally, 36% of Medicaid-insured adults are up to-date on screening compared with 60% of commercially- or Medicare-insured adults.
Medicaid enrollees are over 50% more likely than commercially insured adults to present with advanced-stage colorectal cancer.
Little is known about the effectiveness of Medicaid direct-to- member mailed outreach programs.

5. To evaluate BeneFIT using mixed-methods, assessing
BeneFIT Specific Aims
To support health plans in implementing a mailed FIT outreach program for Medicaid and/or Medicare enrollees in Oregon and Washington
To evaluate BeneFIT using mixed-methods, assessing
Reach
Implementation
Effectiveness
Maintenance
This presentation will present results from the first year effectiveness study.

6. bENEfit Study Methodology
Hybrid implementation-effectiveness study of two mailed FIT program models developed by health insurance plans.
Primary effectiveness outcome: FIT completion rate within 6 months of initial mailing.

7. participating Health Plans
Health Plan Oregon insures about 220,000 Medicaid and dual Medicaid- Medicare enrollees in Oregon.
Health Plan Washington insures about 650,000 Medicaid and dual Medicaid-Medicare enrollees in Washington state.

8. Benefit process The health plans developed two very different models
Quality teams designed their own programs to fit their contexts
Research team provided expertise to the quality teams at the health plans

9. Health plan mailed fit program models
Worked with clinics to confirm the list of eligible enrollees, co-brand mailing materials, and choose FIT test type that was specific to the clinic.
Worked with an outside vendor for mailings.
Collaborative Model
Clinics or providers could opt out if desired.
Worked with an outside vendor for most mailed FIT activities.
Centralized Model

10. Collaborative model
Eligible Enrollees
Medicaid Health Plan
Clinic

11. Collaborative model
Eligible Enrollees
Medicaid Health Plan
Lab
Clinic

12. Centralized model
Lab
Eligible Enrollees
Medicaid Health Plan

13. Centralized model
Lab
Eligible Enrollees
Medicaid Health Plan
Clinic

14. BeneFIT Colorectal Cancer Screening Results by Health Plan

15. Predictors of FIT SCREENING for Enrollees in Oregon and Washington
Patient characteristic OR WA
Effect
Gender -- NS
Preferred language
Race / ethnicity X
Asian / Pacific Islanders/ Native Hawaiians FIT completion than whites
Health insurance
Dual-eligible enrollees FIT completion than Medicaid enrollees
Residence location
Rural residence FIT completion than urban residence
Primary care visits in past year
Enrollees with 1-3 or 4+ visits FIT completion than enrollees with 0 visits
Jean, the next set of slides are long, and you will likely want to decide how to present. You could simply list significant predictors of FIT screening and all CRC screening for BeneFIT-eligible enrollees in OR and WA
We’ve highlighted significant predictors in blue.

16. Effectiveness analysis Conclusions
Health plans implemented two different mailed FIT program models tailored to their resources and culture – a centralized model and a model collaborating with health care systems.
Both program models were effective and reached many individuals who were overdue for CRC screening.
Next steps: evaluate rates of follow-up colonoscopy for positive FITs, as well as adaptations made and outcomes of the year 2 mailed FIT program

17. Benefit dissemination
Three pronged approach
Traditional academic publications
13 paper published, in process, or planned
Presentations at national conferences
10 presentations given or planned
Transforming our research findings into on-the-ground action
More information: Attend communications panel at 2:00pm

18. BeneFIT Research Team Contact Information
Laura-Mae Baldwin, UW co-PI
Gloria Coronado, KPCHR co-PI
Beverly Green, KPWA co-PI
Richard Meenan, KPHCR, co-I
Bill Vollmer, KPCHR, co-I
Jennifer Schneider, KPCHR, co-I
Amanda Petrik, KPCHR, Project Manager
Malaika Schwartz, Project Manager
CDC Project Officer: Jean Shapiro