BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps.

Hints for HEDIS (and more) is a reference tool developed to explore various quality topics, including:

• Definitions, specifications, and exclusions of the many quality measures
• Billing codes used to report gap closure
• Collection and reporting methodologies
• Tips and best practices to maximize gap closure

Colorectal cancer screening – close the gap
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, taking the lives of about 50,000 Americans each year – more than breast cancer (41,000) or prostate cancer (29,000). Despite this, one in every three adults 50 years of age or older is still not getting screened for CRC as recommended.

Facts:

• Measure applies to members 51-75 years as of December 31 of the measurement year.
• Exclusions:
  • Diagnosis and treatment of colorectal cancer during the measurement year
  • History of total colectomy
  • Members receiving hospice care
  • Members who reside in a long-term care facility
  • Frailty and advanced illness exclusions apply but must come through claims data.

Dementia medications dispensed:

Multiple appropriate screening methods—with recommended frequencies—are available to patients:

ACS, American Cancer Society; CT, computed tomography.

Specific health needs and preferences vary among patients, and patients may be more likely to complete screening when given multiple options.

Cologuard® is included in the United States Preventive Services Task Force (USPSTF) clinical guidelines and the 2017 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures published by the National Committee for Quality Assurance (NCQA), with 3 years of quality credit.

Cologuard is a non-invasive stool-based test that detects blood and abnormal DNA associated with CRC and precancer. The collection kit is shipped to and from the patient’s home via UPS, and Exact Sciences Laboratories (ESL) provides results to your practice within a few weeks. Cologuard also includes an embedded patient navigation program administered by ESL that provides follow-up calls and outreach to support patient compliance. You can learn more about Cologuard at www.cologuardtest.com/hcp.

Cologuard is intended for the qualitative detection of colorectal neoplasia-associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by diagnostic colonoscopy.

Cologuard is indicated to screen adults of either sex, 50 years or older, who are at typical average risk for CRC. Cologuard is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.

Cologuard is not for high-risk individuals, including those with a history of colorectal cancer and advanced adenoma, a family history of colorectal cancer, IBD, or certain hereditary syndromes. Positive Cologuard results should be referred to diagnostic colonoscopy. A negative Cologuard test result does not guarantee absence of cancer or advanced adenoma. Following a negative result, patients should continue participating in a screening program at an interval and with a method appropriate for the individual patient. Cologuard performance when used for repeat testing has not been evaluated or established.

There is no single “best” test for every person, each has advantages and disadvantages. Talk to your patients about which test(s) are right for them and how often. Getting screened could save lives! Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gap in care reports, and provide overall HEDIS support to you and your practice. Reach our QCT nurses at QualityHEDIS@bcbsri.org or (401) 459-1005.

References:

1. National Colorectal Cancer Roundtable. Data & Progress. http://nccrt.org/data-progress/. Accessed November 28, 2018.
2. American Cancer Society. American Cancer Society Guideline for Colorectal Cancer Screening. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html. Updated May 30, 2018. Accessed November 28, 2018.
3. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(23):2564-2575.