When CMS’ QIO Program announced a call for Special Innovation Projects (SIPs) in summer 2015, the Great Plains Quality Innovation Network (QIN) – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Kansas, Nebraska, North Dakota and South Dakota – seized the opportunity to propose improving screening rates for colorectal cancer (CRC). CRC is the second leading cause of cancer deaths in both men and women and the third most commonly diagnosed cancer in the United States – and a particular threat in the Midwest. The four states served by the Great Plains QIN have CRC incidence rates that are higher than the national average and CRC screening rates that are far below the national average, particularly among the states’ Native American populations.

Since being awarded a SIP contract in September 2015, the Great Plains QIN has been working in support of the National Colorectal Cancer Roundtable’s “80% by 2018” initiative, which aims to reduce the number of new colon cancer cases and avoidable deaths nationwide by getting 80 percent of patients screened in each state. The Great Plains QIN has focused on recruiting clinics that serve the states’ rural and Native American populations, and has worked with those clinics to establish baseline screening rates and a systematic process for providing screening recommendations and reminders. To date, 82 percent of clinics throughout the four-state region have signed the “80% by 2018” pledge. One particular provider in Kansas, PrairieStar Health Center, implemented a consistent screening policy, patient reminders and electronic health record (EHR) notes across its five practices, and has achieved an 84 percent screening rate thus far.

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"Even if we prevent just one case of colon cancer due to early screening in each of our 45 recruited clinics, we’ll save beneficiaries $1.3 million."

Combining CRC screening with other CMS health quality priorities, like immunizations, has proven instrumental to screening improvements in rural areas, where the distance of colonoscopy centers and the lengthy preparation and testing processes, have presented barriers. The Great Plains QIN has helped flu clinics develop FLU-FIT (fecal immunochemical test) programs, offering at-home CRC tests to patients at the time of their annual flu shots. In collaboration with the American Cancer Society (ACS), the Great Plains QIN hosted a FLU-FIT webinar series to help clinics across the four states get FLU-FIT up and running. As a result, 30 sites launched FLU-FIT programs in 2016.

The Great Plains QIN’s partnerships with state, regional and national stakeholders have been a strong foundation for improvement throughout the region. The QIN has aligned with the ACS, local ACS affiliates, Centers for Disease Control and Prevention grantees, the Health Information Exchanges and Colorectal Cancer Roundtables in each of its four states, as well as partnered with the Great Plains Tribal Chairman’s Health Board and local public health units on or near the tribal areas to support efforts to improve CRC rates within the Native American population. “We and our partners share the same three-part aim of better care and better health at lower cost,” says Denise Kolba, RN, MS, CNS, Program Manager for the Great Plains QIN in South Dakota. “We know that improving CRC screening rates will help decrease the cost of treatment for cancers. In 2009, the mean total CRC cost per Medicare beneficiary was $29,196, which included 12 months of care but excluded things like home health and durable medical equipment. Even if we prevent just one case of colon cancer due to early screening in each of our 45 recruited clinics, we’ll save beneficiaries $1.3 million. Our SIP project will pay for itself.”