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Table 1 Context-based adaptations implemented in the second-year mailed FIT program

From: Health plan adaptations to a mailed outreach program for colorectal cancer screening among Medicaid and Medicare enrollees: the BeneFIT study

Program design* O/W Goal(s) for adaptation Reason(s) for adaptation Health plan-initiated adaptations Context modification level
Reach, engagement Feasibility Fit with recipients Effectiveness, outcomes Implementation efficiency Reduce costs Satisfaction Funding policies (incentives) Funding or resource allocation Social context Service structure Available resources Setting Personnel Population
Population receiving program W            - Refocused program on dual-eligible beneficiaries in WA state**  
Program alignment with priorities/incentives W            - Focus on supporting quality goals, such as Medicare 5-STAR
- Focus on Medicare enrollees as they have more accurate address and prior screening information
O           - Included FIT return in broader patient incentive program within health plan for meeting a range of preventive care needs ($25)   
O           - Began to identify need to prioritize future outreach to health centers serving Medicare enrollees   
Program leadership W              - Transferred full program effort to state health plan Quality Improvement (QI) department involved in year one (previously led by national office)
- Retained some local state QI staff involved in year one/hired new QI director with responsibility to lead program efforts
Vendor to deliver program (for phone calls, letters, FITs) W          - Contracted with new vendor that offered more services, e.g., delivered outreach calls and communicated FIT results to members and primary care providers  
Program expansion O            - Health plan provided three additional staff to support some health centers with chart review, reminder calls, and processing returned kits    
O          - Expanded program to 4 additional health centers  
  1. *Rows with “W” indicate Health Plan Washington; rows with “O” indicate Health Plan Oregon
  2. **Year one included Medicaid and Medicare patients across multiple state