EviCore's preventive care outreach program focuses on identifying and resolving gaps in care through proactive patient outreach.
Screenings for colorectal, breast, lung, and cervical cancers can be life-saving, as early detection can help improve the chances of survival.
Yet, there is still a large percentage of the population that does not get screened. For example, about one-third of Americans who should be tested for colorectal cancer never have been. Another study found that over half of women don’t follow the recommended guidelines for annual mammograms—and nearly a quarter were overdue for a cervical cancer screening. Additionally, 95% of eligible smokers and ex-smokers are not getting screened for lung cancer.
These disheartening figures and the patients behind them are the driving factor behind a program from EviCore health care—the medical benefits management arm of Evernorth Health Services—which focuses on identifying and resolving gaps in care through proactive patient outreach. Evicore's preventative care outreach program can improve patient well-being and lower treatment costs. As an added benefit, it may also increase a health plan’s performance score with Medicare Star Ratings and Healthcare Effectiveness Data and Information Set (HEDIS) metrics.
“One of the most important initiatives that we're working on is our colorectal cancer screening program,” said Dr. Sheldon Scheinert, associate chief medical officer of diagnostic services at EviCore. “This program strives to get as many eligible patients screened for colon cancer as possible. But it also looks to close a second critical gap in patient care—getting patients who test positive in the screening connected for the necessary next step, a diagnostic colonoscopy.”
Reasons Why Some People Still Don’t Get Preventive Screenings
Not only does early detection of cancer improve the chances of survival for patients, it often makes treatment much simpler as well. Additionally, cancer screening is a proven way to reduce long-term health care spending for both patients and payers. Data from the World Health Organization finds that treatment for cancer among patients with an early diagnosis is 2-4 times less expensive than treating people whose cancer is at a more advanced stage.
However, according to the American Cancer Society, many people lack awareness about the benefits of screening—including who’s eligible and at greatest risk for developing cancer. For example, some patients think if they don’t have a family history of cancer, they aren’t at risk and don’t need to be screened. Others believe the misnomer that screening should only be conducted if there are symptoms.
Social determinants of health, like income, education, access to transportation, whether a person is insured, also impact who gets cancer screenings. Some people are concerned with the costs of screening, as well as having to miss work, while others struggle with getting to and from the site of care due to lack of transportation. At Evernorth, we believe that preventive outreach can help expand access and utilization of cancer screening.
A Deeper Look at Preventive Outreach
When it comes to preventive care outreach, EviCore partners with health plans to make the process easy. Here’s how it works: Once a year, a health plan sends their member and provider files to EviCore, and our concierge agents reach out to members through mail, phone calls, and text messages to discuss preventive care and increase awareness about its importance.
Agents work directly with patients to schedule appointments—and even help members find a primary care provider. The concierge agents send members appointment reminders, and then when care is received, work to update the health plan files to indicate completion. For patients who provide permission, agents share test results with providers to improve continuity of care. Additionally, EviCore creates materials for provider offices to inform patients that preventive care outreach is part of their health plan, and why this care is so important for their health.
“EviCore has the right infrastructure in place to customize patient outreach for any type of screening procedure that our clients are focused on, with the aim of improving underutilization,” Dr. Scheinert said.
Health plan administrators who would like to learn more about EviCore’s preventive care outreach can reach out to their primary contact at EviCore or email sales@evicore.com.
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EviCore's Preventive Care Outreach Program
When it comes to preventive care outreach, EviCore partners with health plans to make the process as smooth and easy as possible. The preventive care outreach program can help health plans improve health outcomes, lower costs and increase CMS scores.