Building the Foundation
A Coalition was established in Colorado to support a ballot initiative to amend the state constitution to increase the state tobacco tax and use generated funds to create a strong state healthcare system. The initiative was endorsed by more than 110 organizations across Colorado. 2004 Amendment 35 Tobacco Tax Increase for Health- Related Purposes The amendment passed in November 2004 with >61% voter support. HB 1262 was introduced as enabling legislation and included specific funding to establish a Cancer, Cardiovascular and Pulmonary Disease grant program that included evidence based strategies to increase colorectal cancer screening. The Colorado Colorectal Cancer Taskforce identified the need to provide colorectal cancer screening for the uninsured as one of its top priorities at its 2004 Dialogue for Action meeting. 2005 The University of Colorado Cancer Center responded to the first RFA from the CCPD grants program 2006 In January, the Colorado Colorectal Screening Program (CCSP), a statewide program to provide free screening or diagnostic colonoscopies, to uninsured Coloradans was developed as a partnership between the University of Colorado Cancer Center and Colorado safety net community clinics and their screening and treatment providers. Funded by the new state excise tax on tobacco products, the CCSP successfully embedded screening into primary care, providing patient navigation support and reimbursement for care. Key components include: direct primary care screening referrals, screening and treatment navigation for the patients, strong partnerships between primary care and specialty care, and evaluation. These principles were designed to be consistent with those of the primary care/ patient centered medical home, including seamless access to screening, local control over patient decisions, clinic based patient navigation and coordination of care, and continuous quality improvement. This approach giving the authority to the clinics for assessing patient qualifications, referral and navigation to each local clinic strengthened the clinic’s roles as the medical home for clinical preventive services, catalyzing them to adopt colorectal cancer screening for the underserved as a standard of care when the Affordable Care Act expanded coverage of Medicaid, private insurance through the health exchange and coverage of preventive services recommended by UPSTF. Expansion of patient navigation services for screening for all underserved populations (Medicaid, Medicare, and uninsured) in a sustainable manner is the current goal of CCSP. The program has demonstrated favorable evaluation and cost benefit such that the grant support continues and provides data to help support implementation of patient navigation for colorectal cancer screening in Colorado. |
Current Focus
For nearly ten years, the Program provided no-cost screening colonoscopies to medically underserved Coloradans and assisted these individuals in navigating the health care system by training and providing patient navigators to help address individual and system-level barriers to care. With the implementation of the Affordable Care Act and Colorado's Medicaid expansion, the program shifted its focus to providing patient navigation and alignment of statewide and regional efforts to increase screening and access to care. In 2018, CCSP transitioned to the Colorado Cancer Screening Program. Sustainability Case Studies In 2017, the CCSP program team sought to better understand what data safety-net clinics need in order to make the business case for paying for patient navigation at the primary clinic level. CCSP conducted four case studies with partner clinics to emphasize how a comprehensive screening approach, clinic leadership support, partnership with GI (gastroenterology) specialty care providers, business intelligence tools, and accreditation standards can be used to build the case for sustaining and paying for patient navigation for CRC screening. A PDF of the Case Studies is available below under Resources. Resources
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