Performance Measurement to Enforce CRC Screening Among Medicaid Enrollees

The Medicaid Performance Measures work group has voted to add the colorectal cancer (CRC) screening measure to the 2022 Adults Core Set. This will be taken into consideration when CMS finalizes the measures to be included in the core set. While this is not the end game, it is a good start for stakeholders to begin thinking about meeting CRC screening benchmarks within their Medicaid population.

According to 2018 data from the American Cancer Society, only 54% of age-eligible (50 years and above at that time) Medicaid-insured adults were current with their CRC screening as opposed to 65% of those covered by private health plans, 73% of those covered under Medicare or Medicare and Medicaid, and 80% of Medicare- and privately insured adults. Research has shown that low socioeconomic status and being covered by Medicaid increases the risk of poor CRC prognosis: those covered by Medicaid have a 50% higher likelihood of being diagnosed at late stage of the disease and dying from it.

The reason for this? CMS does not mandate reporting on Medicaid CRC screening rates. In contrast, Medicare CRC screening rates are a core reporting requirement for Medicare Advantage plans, which along with other HEDIS measures influence the reimbursement bonuses and other benefits for health plans. This then forces the health plan to pay attention to, and perform well on, the measures and results in better health outcomes for enrollees. The proof of this concept was evident from the BeneFIT program that monitored CRC screening rates among two Medicaid managed care plans: one in Oregon (which was required to report on the screening rates) and the other in Washington state (reporting was not mandated). While the Washington plan stopped mailing FIT kits to its Medicaid enrollees by the second year of the program, the Orgon plan expanded its program to add more Medicaid enrollees.

The hope is that once CMS integrates the measure in the 2022 Adult Core Set, CRC screening rates in the Medicaid population will improve and will translate into prevention, earlier detection, and potentially reduced mortality from CRC.

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