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Health Plan Policies and Programs for CRC Screening

Objectives: This study focused on health plans’ coverage policies, guidelines, and organized programs to promote colorectal cancer (CRC) screening using fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and double-contrast barium enema (DCBE); whether the plan had issued guidelines on CRC screening to its providers; and systems for recruiting patients into screening and for tracking and reporting results of screening and follow-up procedures.

Results: Nearly all plans covered at least one CRC screening modality. Plans were most likely to cover FOBT (97 percent) and least likely to cover colonoscopy (57 percent). In at least one-third of plans, patients incurred out-of-pocket charges for CRC screening. Sixty-five percent had issued guidelines on CRC screening to providers. One-quarter had a reminder mechanism for patients who are due for CRC screening, but fewer had systems for prompting providers, contacting noncompliant patients, or tracking completion of screening.

Conclusions: The ability of health plans to provide a broad range of preventive services to well-defined populations presents greater potential for improving CRC screening rates than do traditional fee-for-service plans. However, few health plans had all three essential CRC screening delivery components -- coverage, guidelines, and tracking systems -- in place in 1999-2000.

Reference: Klabunde CN, Riley GF, Mandelson MT, Frame PS, Brown ML. Health plan policies and programs for colorectal cancer screening: a national profile. Am J Manag Care 2004 Apr;10(4):273-9. [View Abstract]

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Last Modified: 11 Apr 2014