Legislation can be an important way both to generate interest in a particular trial and to sustain its impacts.  At the onset of the Strategies and Opportunities to Stop Colorectal Cancer (STOP CRC) in Priority Populations trial, colorectal cancer screening was adopted as an incentive metric for Oregon’s Coordinated Care Organizations (CCOs, the Oregon equivalent of Accountable Care Organizations). This meant that Medicaid Health Plans and CCOs would receive incentives for reaching performance or improvement targets for colorectal cancer screening. The initial performance target was set at 47%, and the improvement target was set at 3%. Over the subsequent years, additional state legislation was passed to reduce patient out-of-pocket costs for colorectal cancer screening. In 2014, passed legislation required that a colonoscopy initiated as a screening procedure be billed as a screening procedure—even when polyps were removed. Legislation passed in 2015 further required payers to cover the cost of a follow-up colonoscopy (with no out-of-pocket costs) among patients who screened positive on fecal testing.

Case Example: STOP CRC

• STOP CRC improves the rates of colorectal-cancer screening by mailing fecal immunochemical testing kits to patients at Federally Qualified Health Centers. STOP CRC has explored facilitators for use (e.g., making it more user-friendly by using wordless instructions). Clinics also used plan-do-study-act (PDSA) cycles for exploring additional implementation strategies (e.g., improving workflow for printing and mailing kits and enhancements to patient materials).