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Table 2 Content-based adaptations implemented in the second-year mailed FIT program for Health Plan Oregon and Health Plan Washington

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

Program component* O/W Goal(s) for adaptation Reason(s) for adaptation Health plan-initiated adaptations Content modification level* Nature of content modifications*
Reach, engagement Feasibility/implementation Fit with recipients Effectiveness, outcomes Implementation efficiency Reduce costs Satisfaction Funding policies (incentives) Service structure Available resources Time constraints Billing constraints Provider perception of intervention Organizational (health plan) Unit (health centers) Provider Population (enrollees) Network systems (e.g., vendor) Community Tailoring/tweaking/refining** Adding elements Removing elements Re-ordering elements Condensing timeline Substituting elements
Identify eligible adults and obtain accurate contact information W              - Vendor obtained updated contact and enrollment information from member, if needed           
O              - Increased patient address review in health record and mailing list
- Improved capture of prior colorectal screening
Select FIT type W              - Selected vendor that offered a 1-sample FIT kit (previous vendor used 2-sample kit)        
Deliver program components (letters, phone calls, FIT kits) W         - Vendor mailed introductory letter and attempted up to 3 live calls to obtain patient permission to mail kit           
- Vendor mailed FITs only to interested members, reached through live call           
- Health plan mailed invitation letter to members having no phone number, asking them to contact the plan to participate           
O            - Sent introductory letters (no FIT kit) to patients with no assigned provider or no clinic visits in last 12 months        
O             - Increased delivery of FIT reminders by health center staff (sometimes prioritized to Medicare enrollees)           
Communicate test results W           - Vendor mailed result letter to member (normal and abnormal)           
- Vendor concurrently informed PCP of abnormal result so PCP could order follow-up colonoscopy            
- Vendor called enrollees with abnormal FIT results         
Streamline implementation O           - Directly obtained kits from lab on behalf of clinics
- Improved vendor billing process
O            - Conducted a one-time (rather than split) mailing per health center        
  1. *Rows with “W” indicate Health Plan Washington; rows with “O” indicate Health Plan Oregon