Colon Cancer
Sample MCO Healthcare Services, Inc. Colon Cancer Screening Initiative: Medivo Program Protocols
Client: Sample MCO Healthcare Services, Inc (MCO)
Test: Fecal Occult Blood (FOB) Home Test Kit, screening test for Colon Cancer
Dates: late 2009/early 2010
MCO contracted with a major U.S. laboratory and Medivo to conduct an FOB Test for a targeted list of its members, using a home test kit specimen collection method, with state by state physician oversight provided using Medivo’s online platform and technology to facilitate lab test review/approval/results by Medivo’s contracted physician network with a minimum of 1 credentialed physician in all 50 states.
PROCESS
Initially MCO sent information to a targeted list of members with a reply card for those who requested to participate in the program. MCO provided an eligibility file of this list of participants who sent back a reply card to the laboratory, which contained the following demographics:
First and Last Name
Address
Phone number
Date of Birth
Gender
The laboratory sent this file to MEDIVO via a secure connection.
All individuals in the eligibility file are uploaded by Medivo into the vCare platform which allows each individual’s lab test request to be reviewed by a Medivo physician licensed and residing in the individual participants’ respective states of residence.
For all patients who meet the colon cancer screening protocol, the lab test requests are approved. For those patients who do not meet the lab test protocol, or for whom the Medivo physician has additional questions, the lab test requests are not approved, but sent back to the laboratory with an explanation and/or request for more information.
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Summary Findings:
This MCO-Laboratory-Medivo program was highly successful in screening a large population for colon cancer. Nearly 5,000 MCO beneficiaries directly requested a home FOB kit, and over 1 in 3 returned the kit with valid samples for analysis. An overall rate of 4.71% of abnormals were observed, and these individuals were provided communication to follow-up with their local physicians for further testing, including colonoscopy.
In reviewing the data, several interesting trends emerged. Males were more frequently abnormal than females (5.62% vs 3.83% respectively). In general higher age categories were associated with higher rates of abnormals. Wisconsin and Missouri had lower abnormal rates than Illinois and Kansas (3.8%/4.7% vs 10.2%/7.4% respectively).
Lessons for Future Screening Programs:
- The model of using virtual lab ordering/resulting with home testing kits was a very convenient one for the individuals who responded, they were able to get screened for colon cancer with physician oversight and outreach on their results, without going to a separate doctor’s appointment or two to get the screening completed and results released.
- Designing recruitment strategies using validated incentive systems may increase the response rates. While over 55,000 letters were sent out to a targeted group of beneficiaries, and a relatively robust 8.65% of the recipients requested the kits (better than typical direct mail campaign results by a factor of ~3), it seems that increasing this rate would be the most effective means of dramatically increasing the penetration rate of the screening effort.
- It would also be helpful to understand the targeting algorithm itself and why certain states had so many beneficiaries and others so few, because the demographics and/or job descriptions and/or other descriptive characteristics of these individuals could be correlated against the outcomes that were observed. Specifically the relative rates of abnormals across the age ranges, genders, and states of residence will have different implications based on the algorithm of who was targeted, and for what reasons.