Oregon Medicaid Model
Interventions
You have the option to compare up to 5 evidence-based interventions to usual care (i.e. no intervention) in Oregon. Each of the 5 interventions are described below. We have provided our best estimates of the expected effectiveness and cost when implemented among more than 68,000 Oregon Medicaid enrollees ages 50-64. We derived these estimates from a review of prior studies, focusing specifically on studies that implemented these types of interventions in populations similar to the Oregon Medicaid population (e.g., low-income or Medicaid populations, located in the northwest, etc.).
Select each intervention that you would like to include in your simulation. As you do so, consider whether you think the effectiveness and costs might be different from the current estimates and, if so, by how much.
Patient Reminders
In this model, we evaluated a phone-based patient reminder approach, but other literature has assessed other modalities for reminders (e.g., letters). If you want to consider a different version of this intervention, consider what impact that may have on the effectiveness and cost. We assumed patients receive an automated call to notify them that they are overdue for CRC screening. The automated message includes the notification that they are overdue, brief information about why CRC screening is important, and information about various options for screening (e.g., FIT or colonoscopy)
We estimate that the intervention effectiveness, or relative risk, is 1.26 (i.e., patients are 26% more likely to be screened with the intervention compared to usual care). We estimate the total cost per patient is $1.43 (see individual cost components below).
| Intervention components | Cost per patient |
|---|---|
| Technical staff (to manage automatic calls, maintain the electronic health records, track patients, etc.) | $0.79 |
| Automated phone reminder to complete FIT | $0.64 |
| Total cost: | $1.43 |
Download additional details about the estimated effectiveness and cost of this intervention, including the specific studies that informed our estimates.
Mailed FIT
In this model, we evaluated a program in which patients receive a notification mailed to their house to alert them that they are due for CRC screening and will be receiving a fecal immunochemical test (FIT) kit in the mail. Shortly after, patients receive a package by mail that includes: a low literacy information sheet about CRC and why screening is important, a FIT, directions for how to complete the FIT, and a pre-addressed envelope with a stamp to return the FIT for processing. They can complete the FIT at home and return it to the clinic via mail (or they can contact the clinic to schedule a colonoscopy). Mailed FIT programs often include additional patient reminders if patients do not return their FIT tests. We assumed that patients receive up to two automated phone calls to remind them to complete the FIT if they have not mailed it back.
We estimate that the intervention effectiveness, or relative risk, is 2.17 (i.e., patients are 117% more likely to be screened with the intervention compared to usual care). We estimate the total cost per patient is $6.55 (see individual cost components below).
| Intervention components | Cost per patient |
|---|---|
| FIT kit* | $3.27 |
| Mailing costs: postage, stamps, envelopes, paper, and materials (letter from provider, fact sheet, instructions for FIT use) | $1.35 |
| Project management staff (to fill envelopes, manage the project, etc.) | $0.50 |
| Technical staff (to manage automatic calls, maintain the electronic health records, track patients, etc.) | $0.79 |
| Automated phone reminder to complete FIT | $0.64 |
| Total cost: | $6.55 |
*We assumed the cost of follow-up of abnormal FIT tests (i.e., diagnostic colonoscopy) is included under screening costs, rather than intervention implementation costs.
Download additional details about the estimated effectiveness and cost of this intervention, including the specific studies that informed our estimates.
Patient Navigation
In this model, we evaluated a program in which a trained patient navigator calls eligible patients to help “navigate” them towards getting screened for CRC with the goal of overcoming any barriers to screening, and to support diagnostic testing and treatment initiation. Patients receive individualized assistance such that the navigator's actions are dependent on what each patient needs. Navigation may include explaining why CRC screening is important, describing where and how to get screened, helping to arrange transportation to a screening center, ordering a FIT to the patient's house, and answering questions about CRC screening. If you want to consider a navigation program that offers more or less intensive services, consider what impact that may have on the effectiveness and cost.
We estimate that the intervention effectiveness, or relative risk, is 1.65 (i.e., patients are 65% more likely to be screened with the intervention compared to usual care). We estimate the total cost per patient is $38.45 (see individual cost components below).
| Intervention components | Cost per patient |
|---|---|
| Navigator staff (to make the navigation calls) | $35.41 |
| Technical staff (to develop and maintain system, keep track of who is up-to-date on screening and who needs a phone reminder) | $0.79 |
| Navigator training* | $2.25 |
| Total cost: | $38.45 |
*We assumed that training for each navigator costs $1,123.45 and that each navigator can assist 500 patients (which equates to $2.25 per patient). The navigator training cost includes the initial training as well as some adjustment for staff turnover.
Download additional details about the estimated effectiveness and cost of this intervention, including the specific studies that informed our estimates.
Mailed FIT + Patient Navigation
In this model, we evaluated the combination of the mailed FIT and patient navigation interventions, as described above. In this case where mailed FIT and patient navigation are combined, we assumed that navigators focus more commonly on FIT completion or follow-up after an abnormal FIT.
We estimate that the intervention effectiveness, or relative risk, is 2.43 (i.e., patients are 143% more likely to be screened with the intervention compared to usual care). We estimate the total intervention cost is $45.00 (see individual cost components below).
| Intervention components | Cost per patient |
|---|---|
| FIT kit* | $3.27 |
| Mailing costs: postage, stamps, envelopes, paper, and materials (letter from provider, fact sheet, instructions for FIT use) | $1.35 |
| Project management staff (to fill envelopes, manage the project, etc.) | $0.50 |
| Technical staff (to manage automatic calls, maintain the electronic health records, track patients, etc.) | $0.79 |
| Automated phone reminder to complete FIT | $0.64 |
| Navigator staff (to make the navigation calls) | $35.41 |
| Technical staff (to develop and maintain system, keep track of who is up-to-date on screening and who needs a phone reminder) | $0.79 |
| Navigator training** | $2.25 |
| Total cost: | $45.00 |
*We assumed the cost of follow-up of abnormal FIT tests (i.e., diagnostic colonoscopy) is included under screening costs, rather than intervention implementation costs.
**We assumed that training for each navigator costs $1,123.45 and that each navigator can assist 500 patients (which equates to $2.25 per patient). The navigator training cost includes the initial training as well as some adjustment for staff turnover.
Download additional details about the estimated effectiveness and cost of this intervention, including the specific studies that informed our estimates.
Academic Detailing + Provider Assessment & Feedback (Detailing+)
Academic detailing and provider assessment and feedback programs are clinic-level interventions that typically consist of provider education and monitoring of CRC screening practices. In this model, we assumed that provider training is provided onsite and covers the importance of CRC screening, how to talk to patients about CRC screening, and best-practices for encouraging patients to get screened for CRC. In addition, each provider receives an individual quarterly report describing progress in boosting CRC screening rates among patients, including specialized recommendations for improvement.
We estimate that the intervention effectiveness, or relative risk, is 1.27 (i.e., patients are 27% more likely to be screened with the intervention compared to usual care). We estimate the total cost per clinic is $1,586.46 (see individual cost components below).
| Intervention components | Cost per clinic* |
|---|---|
| Physician training sessions | $970.25 |
| Technical and programming staff | $207.91 |
| Quarterly meetings with updates | $408.30 |
| Total cost: | $1,586.46 |
*We assume that this intervention is offered at all clinics serving the target population. In Oregon, we assumed that 900 clinics would receive this intervention costing $1,586.46 per clinic. We assumed that this cost of implementation is only required during the first year, whereas the other interventions simulated are required annually during the 5-year intervention window.
Download additional details about the estimated effectiveness and cost of this intervention, including the specific studies that informed our estimates.