Problem: While Michigan’s incidence rates for breast, cervical and colorectal cancers were lower than the national average1, death rates were higher. Cancer screening was identified as a priority due to low screening rates for these cancers.
1U.S. Cancer Statistics Working Group. (2017). United States Cancer Statistics: 1999-2014 Incidence and Mortality Web-Based Report. Retrieved from www.cdc.gov/uscs
PSE Change Solution: The Michigan Cancer Consortium (MCC) helped member organizations – including hospitals, health departments, universities, trade organizations and advocacy groups – use evidence-based strategies from the Guide to Community Preventive Services to improve their employees’ cancer screening rates. Participants completed internal assessments to identify existing policies addressing cancer screening, then created action plans. Next steps included education and environmental changes to support existing policies, along with collaborations between employers and their health insurers – including collaborations to monitor and report screening rates. More than 12,000 employees and dependents of 10 participating members were reached during the initiative, with increased screening rates seen in each.
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Problem
In Michigan, cancer screening was identified as a priority due to low screening rates for breast, cervical and colorectal cancers.
Michigan’s age-adjusted cancer incidence rate (per 100,000 persons) in 2010 was 118 for female breast cancer (121.5 in the US), 41.1 for colorectal cancer (41.6 in the US) and 6.8 for cervical cancer (7.7 in the US) (United States Cancer Statistics [USCS], 2017). While the state’s incidence rates for these three cancers were lower than the national average, the death rates were higher. Michigan’s age-adjusted cancer mortality rate (per 100,000 persons) in 2010 was 23.7 for female breast cancer (21.9 in the US), 15.6 for colorectal cancer (15.5 in the US) and 2.2 for cervical cancer (2.3 in the US) (USCS, 2017).
PSE Solution
The goal of the Michigan Cancer Consortium (MCC) Challenge was to help member organizations use evidence-based strategies from The Guide to Community Preventive Services (The Community Guide) to improve their employees’ cancer screening rates. From 2011-2014, a total of 10 MCC member organizations participated in the MCC Challenge for at least one year, reaching more than 12,000 employees and their dependents. Eight organizations participated in the first year; five of them continued during the second year, along with two new organizations. Three organizations that had participated previously re-joined the Challenge in the third year. During the fourth year, the project expanded to the primary care setting and focused on sending screening reminders to an identified patient population.
Actions/Results
The steps taken as part of this successful PSE change effort were:
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Key partners in this PSE change effort were MCC member organizations. These organizations include hospitals, health departments, universities, trade organizations and advocacy groups. Michigan’s Comprehensive Cancer Control Program recruited participants from these organizations for the MCC Challenge (Step 1: Engage).
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A scan by the Michigan Department of Health and Human Services (MDHHS) considered recommended strategies from the Community Preventive Services Task Force available in The Community Guide on using evidence-based interventions to increase breast, cervical or colorectal cancer screening. All organizations participating in the MCC Challenge completed an internal assessment, which determined if organizational policies were in place regarding breast, cervical and colorectal cancer screenings for employees and their dependents. The assessment identified knowledge gaps and current cancer screening rates among those employee populations using Healthcare Effectiveness Data and Information Set (HEDIS) measures (Step 2: Scan and Step 3: Assess).
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Based on the initial policy assessment and baseline screening rates, organizations created action plans to implement over the next year. If organizations already had recommended policies in place, then education or environmental changes to support those policies were encouraged (Step 4: Review).
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During the first year of the MCC Challenge, participating organizations, employees and their dependents were educated on the benefits of and opportunities for cancer screenings (Step 5: Promote).
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Participating organizations collaborated with their health insurers and sent screening reminders to employees who were never screened or were due for screening. The screening reminders were created using Make It Your Own (MIYO). MIYO is an online resource used to create customized health information materials for specific populations. MDHHS provided technical and financial support for printing and postage. Health insurers shared aggregate screening rates with the organizations at baseline, 3, 6 and 12 months (Step 6: Implement).
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The results of the MCC Challenge were near or exceeded The Community Guide recommendations. Screening rates reported by the member organizations improved in nearly every instance (Step 7: Evaluate).
Success Factors and Key Questions Addressed
What difference(s) did the PSE change make in the short-term?
During the first year, approximately 7,000 employees and dependents of the participating MCC organizations were reached by the Challenge. In August 2012, after one year of participating in the MCC Challenge, the organizations again reviewed their HEDIS screening measures. Many organizations were able to increase screening rates for all three cancers. Individual successes after the first year included:
- Karmanos Cancer Institute instituted a new policy to use group education to inform employees of their insurance coverage for cancer screening and the benefits of being screened.
- Catherine’s Health Center obtained a group health plan for the first time, fully covering all copayments and deductibles for breast, cervical, and colorectal cancer screenings.
- Northwest Health Department continued to enhance their wellness initiatives, which had a 98% participation rate, by including incentives for employees.
- HealthPlus of Michigan also offered incentives for their employees to complete their cancer screenings and used small media to educate their employees.
All of the organizations reported that they provide paid time off for employees to attend doctor’s visits, have extended coverage for family members and reduce out-of-pocket costs by assisting with or covering the entire cost of the copayment. After the success of the first year, the MCC continued to encourage their organizations to take the MCC challenge.
In year 3, one organization’s colorectal cancer (CRC) screening rate increased from 67% to 88%. Another organization increased its CRC screening rate from 38% to 45%. A third organization that focused on clients who were overdue for CRC screening was able to get 25% of the overdue population to complete a CRC screening within one year.
What difference(s) did the PSE change make in the long-term?
Each entity saw improved screening rates. Evidence-based screening interventions were successfully integrated into organizations’ worksite policies.
How did you measure/document the impact of the PSE change intervention?
Throughout the process of implementing this intervention, participating organizations stated that the strategies from The Community Guide encouraged a positive culture around cancer screening at their workplaces. Many of these organizations collaborated with their health insurers to monitor and report screening rates and reported improved communications with their insurers, which led to stronger relationships and a more routine analysis of their HEDIS measures.
How did you measure/document the impact of the PSE change intervention?
Throughout the process of implementing this intervention, participating organizations stated that the strategies from the Community Guide encouraged a positive culture around cancer screening at their workplaces. Many of these organizations collaborated with their health insurers to monitor and report screening rates and reported improved communication with their insurers, which led to stronger relationships and a more routine analysis of their HEDIS measures.
Were there barriers to implementing the PSE change? If so, what were the lessons learned?
Some barriers included:
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Staff turnover within some organizations completing the MCC Challenge led to delays in assessment or inability to report data.
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Organizations did not have strong relationships with their health insurers, which led to difficulty in accessing data to track employee screening rates. This resulted in an inability to report data.
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Each organization had different resources and abilities, which may have led to differences in outcomes.
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A short timeline for the MCC Challenge application and assessment may have kept some organizations from participating.
Lessons learned included:
- Partnerships are key! Employers need to partner with their health insurers to track cancer screening rates for their employees.
- Small-scale success creates big opportunities. Success in the early years of the MCC Challenge led to recent parallel projects, including projects that address physician offices and selected patient populations.
- No organization is too big or too small to take on the MCC Challenge, as increases in cancer screening rates were seen across all organization sizes.
Related Resources
Visit The Community Guide for evidence-based interventions to improve health and prevent disease in your state, community, community organization, business, health care organization or school. For more information about the MCC Challenge, please visit the Michigan Cancer Consortium website or contact burtons4@michigan.gov for additional resources. Visit Make it Your Own (MIYO) for customizable health communication materials.
REFERENCES
U.S. Cancer Statistics Working Group. (2017). United States Cancer Statistics: 1999-2014 Incidence and Mortality Web-Based Report. Retrieved from www.cdc.gov/uscs
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Resources to Support Similar Evidence-Based Initiatives
What Works for Health
Evidence-Based Cancer Control Programs
Filter programs by Program Area and Colorectal Cancer Screening
The Community Guide
What Works Fact Sheet: Cancer Screening
Evidence-Based Intervention Planning Guides