History of Demonstration Program

Although colorectal cancer screening has been shown to decrease incidence and mortality from this disease, use of colorectal cancer screening tests has been lower than use of other well accepted preventive services. As of 2006, 61% of the U.S. population has been screened for colorectal cancer as recommended,¹ with those without health insurance least likely to get screened. To explore the feasibility of implementing a national screening program for the underserved population and to learn which settings and program models may be most feasible and cost-effective, CDC established a 3-year colorectal cancer screening demonstration program (CRCSDP).

CDC convened two stakeholder meetings in 2004 to consider possible program designs, identify eligibility criteria for program applicants and clients receiving services, and determine which services would be reimbursed in the program. Meeting attendees included health scientists, economists, epidemiologists, and program and communications experts from CDC, as well as health scientists from other federal health agencies; representatives from screening programs from U.S. states and other countries; and clinical experts. The following recommendations were made regarding the design of the CRCSDP:

• Eligible applicants could come from any non-profit medical entity offering services to low-income persons underinsured for colorectal cancer
• State or county health departments or
• Hospital systems or
• National Breast and Cervical Cancer Early Detection Program or other
• Eligible applicants must show collaboration with the CDC-funded Comprehensive Cancer Control Program in their state
• In light of the current menu of four screening tests recommended by the U.S. Preventive Services Task Force (USPSTF), with no one “best” test recommended, applicants could choose which CRC screening test(s) to offer as long as
• the selected test(s) is/are recommended by USPSTF guidelines and
• the applicant had measured the capacity to offer the selected test(s)
• Screening tests would be reimbursed at the Medicare rate
• The program would focus primarily on average-risk persons aged 50 years or older
• Patients with colorectal cancer symptoms or certain high-risk conditions would not receive services within the program
• Treatment resources would need to be identified prior to programs applying to part of the demonstration effort
• Priority would be given to programs ready to begin screening within 6 months

A Request for Application was published in the Federal Register in May 2005. Reviewers for the applications were from CDC and other federal health agencies. Cooperative agreement awards between CDC and 5 programs were made for August 2005 through August 2008. CDC awarded $2.1 million for year one activities, and $2.6 million annually for years two and three.

Reference

¹DeGroff A, Holden D, Green SG, Boehm J, Seeff LC, Tangka F. Start-up of the colorectal cancer screening demonstration program. Preventing Chronic Disease 2008;5(2):A38.