This article is for primary care providers caring for our Medicare Advantage and Federal Employee Program members
In June, we’re sending letters to our members who may be due for a colorectal cancer screening to let them know that they’re eligible to receive a Cologuard®′ kit. These will be sent to members who are at average risk for colon cancer.1
Cologuard is a covered, non-invasive screening option that members can complete from the comfort of their home. It is available at a $0 copay.
Who is eligible for Cologuard?
Using our claims data, we identified Medicare Advantage and Federal Employee Program (FEP) members who are at average risk of colon cancer and are due for a colorectal cancer screening. Members with claims for “high risk conditions” (for example, inflammatory bowel disease, family history of malignancy, etc.) are excluded from this program.
We’ve sent letters to primary care providers (PCPs) with a list of patients who will receive the kit. This gave PCPs the opportunity to have their members who are not clinically appropriate excluded from the information being shared with Exact Sciences at the end of May.
Since colorectal cancer screening was included in the HEDIS Electronic Clinical Data Systems (ECDS) reporting beginning in 2024, data available this year should be much more accurate in identifying patients who may have had prior screening done with another payer.
About the kits
We’re working with Exact Sciences, an independent health screening organization, to send Cologuard kits. Identified members will receive a letter notifying them that they are eligible to receive a kit and how to opt out. The letter includes explicit instructions about who should or should not complete the screening. We will continue to refer members that we identify as having an increased risk back to you to review which screening options are available to them.
Cologuard should not be used if the member:
- Has a history of colorectal cancer, polyps, or other related cancers.
- Had a positive result from another colorectal cancer screening test within the last six months.
- Has a condition that places them at high risk for colorectal cancer, including inflammatory bowel disease (IBD) or certain hereditary syndromes or a family history of colorectal cancer.
How will members receive the kit?
Members will complete the test using the instructions included in the kit and mail their samples back to Exact Sciences for analysis. Exact Sciences will mail results to the member within two weeks after receiving the Cologuard sample. PCPs will receive these results directly from Exact Sciences. Practices using EPIC can leverage EPIC Care Everywhere to retrieve patient results.
Member letter sample
Here’s a sample of what we sent to our members:
MPC_070224-2P-6-ART
- INDICATIONS AND IMPORTANT RISK INFORMATION: Cologuard is intended to screen adults 45 years of age and older who are at average risk for colorectal cancer by detecting certain DNA markers and blood in the stool. Cologuard is not a replacement for colonoscopy in high-risk patients. Patients with a positive test result should be referred for colonoscopy. A negative test result does not confirm the absence of cancer. Patients with a negative test result should discuss with their doctor when they need to be tested again.
- We’re working with Exact Sciences and Recuro Health, an independent health screening organization, to send Cologuard kits to members. Cologuard is shipped through the provider, Exact Sciences, who works with clinicians at Recuro Health to order Cologuard for the member.