Key Payer Strategies to Improve Colorectal Cancer Preventive Care

Risk factors for colorectal cancer are growing more prevalent even in younger age groups, meaning payers need to improve colorectal cancer preventive care, a Blue Cross Blue Shield Association (BCBSA) report found.

“While the overall rate of colorectal cancer diagnoses remained steady through 2018, the prevalence of conditions that increase the risk for colorectal cancer has increased dramatically,” the study explained. “This trend among millennials significantly increases the risk of future diagnoses of colorectal cancer.”

Certain chronic diseases tend to be risk factors for colorectal cancer, diseases such as Crohn’s disease, ulcerative colitis, diabetes, and obesity. Patients with Crohn’s and ulcerative colitis are at nearly twice the risk for colorectal cancer as patients without these chronic diseases.

These risk factors are becoming particularly widespread among millennials. Crohn’s, ulcerative colitis, and diabetes saw double-digit increases in prevalence among millennials from 2014 to 2018, and obesity diagnoses jumped by 100 percent in that four-year time span.

However, at-risk members—both young and old—are avoiding colorectal cancer screenings.

The fact that colorectal cancer risk increases by 50 percent between ages 50 and 55 underscores the need for more senior patients to undergo screenings for this disease. Still, the report discovered that only three in 10 people between 50 and 52 have been screened.

Contrary to popular perception, older adults are not the only ones who require screening for this disease.

While colorectal cancer screenings typically begin at age 50, in accordance with US Preventive Services Task Force guidelines, those with risk factors need to be screened early, the report stressed. In spite of this, less than a third of individuals under age 50 with risky chronic diseases were screened for colorectal cancer in the past two years.

Lack of widespread screening for colorectal cancer can have major implications down the road for members and payers alike, Reed Melton, vice president of clinical operations at BCBSA, explained to HealthPayerIntelligence.com via an email interview.

“While the rate of colorectal cancer has remained largely steady, there has been a notable increase in the prevalence of known risk factors among younger age groups – including millennials – which points to potential issues down the line for patients, and ultimately providers and payers too,” Melton said.

Preventable cancers, including colorectal cancer, drive some of the highest healthcare spending in America, according to a report from The Mesothelioma Center. Overall, cancer costs the nation $150 billion per year,  remaining one of the top ten most expensive chronic diseases.

“If screening rates do not improve in the years to come for these groups, there is a risk of seeing a significant increase in future diagnoses of colorectal cancer,” Melton emphasized.

Members were avoiding screenings largely due to misunderstanding about the risks and the process, BCBSA found, particularly for older adults.

More than six in 10 survey participants who were 50 years of age and older (61 percent) responded that the major barrier to screening was that they found the screening process to be uncomfortable, either emotionally or physically.

For younger, at-risk individuals between the ages of 18 and 49, the issue was primarily knowledge-based. Fifty-eight percent in this demographic said that their primary care provider had not told them that they needed to be screened and that this was the main obstacle to screening.

“A major barrier to preventative screening is attitudinal – stemming from misperceptions surrounding discomfort, lack of risk awareness, and general fear of negative results,” Melton said. “Payers can start by working to change those perceptions and provide accurate, accessible resources to better inform the public.”

Payers can act on the information that this report unveiled by making colorectal cancer information—including screening information and other data—available to members online. This is a strategy that many Blue Cross and Blue Shield companies are already implementing.

“Our goal is to highlight how effective regular screenings are for identifying colorectal cancer earlier, helping to improve treatment outcomes,” Melton noted.

One Blue Cross and Blue Shield company— Excellus BlueCross BlueShield—has a team dedicated to closing gaps in care for members who are at risk of colorectal cancer. The payer surveyed its member population to discern and solve for barriers to cancer screenings.

Another chronic disease prevention strategy for members at risk of colorectal cancer is to offer telehealth, virtual care, and other at-home prevention methods.

“BCBS companies across the nation continue to encourage members to use telehealth and other virtual preventative care options when appropriate so that they can get and stay healthy from the safety of their own home,” Melton said.

Premera,  a Blue Cross and Blue Shield company,  sent out colorectal cancer testing kits to rural communities so they could better access preventive care. This is an approach other payers have used for diabetes and colon cancer, a specific type of colorectal cancer.

By implementing strategies to increase screenings, improve member awareness, and broaden access to preventive care through telehealth, virtual care, and testing kits, payers can be instrumental in enabling members’ chronic disease prevention and management for colorectal cancer.