Improving Quality Measurement for Colorectal Cancer Screening

April 12, 2022 · Fern McCree

Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. [1] While routine screening can find cancer early when treatment is most effective [2], many adults do not get recommended screenings. [3]

To address these gaps and support more equitable care, NCQA recently announced several important updates to the widely used Colorectal Cancer Screening HEDIS measure.

Begin Routine Screening Earlier and for Broader Populations. The U.S. Preventive Services Task Force, an independent panel of medical experts, now recommends that colorectal cancer screening start at age 45 instead of age 50. While the majority of colorectal cancer diagnoses are among people age 50 and older, incidence is rising in younger adults. [4] Therefore, NCQA updated the measure to include people age 45 – 49 in addition to those age 50 – 75. NCQA also newly applied the measure to Medicaid health plans. This aligns with efforts at the state level, where the measure will be included in the Centers for Medicare & Medicaid Services Adult Core Set, enabling states to monitor trends in performance on the quality of care provided to Medicaid enrollees.

Address Racial and Ethnic Disparities in Care. While overall rates of colorectal cancer are decreasing, there are disparities in incidence and mortality among racial and ethnic minorities. Inequalities in screening, follow-up and treatment may contribute to these disparities. [5] Thus, NCQA now requires reporting by race and ethnicity in the Colorectal Cancer Screening measure. NCQA will implement the stratifications in other HEDIS measures over the next several years.    

Leveraging Electronic Clinical Data for Measurement and Care Improvement. The Colorectal Cancer Screening measure will exclusively use the HEDIS Electronic Clinical Data Systems (ECDS) reporting standard beginning in measurement year 2024. This presents an opportunity for health plans, providers, and vendors to adopt interoperability standards that will support the exchange of clinical data.

The ECDS reporting standard allows plans to use data from a variety of sources, including administrative claims, case management systems, registries, and electronic health records. Importantly, it requires collection and reporting of electronic clinical data in a standardized way. Leveraging electronic clinical data enriches the information available to care teams and patients. Standardized data collection supports the ability of providers to securely and appropriately share that information to improve patient care.

NCQA developed a resource guide to support health plans and other stakeholders in leveraging electronic clinical data to report the Colorectal Cancer Screening measure for HEDIS. The strategies and resources outlined in this guide can also be adapted to other quality measure and improvement use cases.

Looking Ahead

Moving forward, NCQA is developing new HEDIS measures and enhancing existing measures to leverage more electronic clinical data, allowing us to address important concepts such as assessing social determinants of health and improving clinical outcomes for chronic conditions. To learn more, see episode 11 of the Future of HEDIS webinar series.

To stay up-to-date with new announcements and resources related to the ECDS reporting standard, please visit our ECDS webpage.

[1] National Cancer Institute. 2021. “SEER Cancer Stat Facts: Colorectal Cancer.” National Cancer Institute Surveillance, Epidemiology, and End Results Program. Last accessed April 11, 2021. 

[2] ACS. 2020. “Colorectal Cancer Early Detection, Diagnosis, and Staging.” American Cancer Society. Last modified June 2020.

[3] USPSTF. 2021. “Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement.” JAMA 325(19): 1965-1977. doi:10.1001/jama.2021.6238. 

[4] Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. “Screening for Colorectal Cancer: An Evidence Update for the US Preventive Services Task Force. Evidence Synthesis No. 202.” Agency for Healthcare Research and Quality; 2021. AHRQ publication 20-05271-EF-1.

[5] Brawley, O.W. 2014. “Colorectal cancer control: providing adequate care to those who need it.” J Natl Cancer Inst 106(4):dju075. doi: 10.1093/jnci/dju075.

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