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Federal and state agencies, as well as health insurance companies, use Quality Performance Measures (QPM’s) to determine the effectiveness of healthcare programs and compare quality of care. QPM’s directly impact payments and other financial incentives, as well as accreditation. For Medicare patients, there is a set of quality standards for colorectal cancer. These standards provide a strong incentive for Medicare Advantage programs to focus on colorectal cancer, as plans meeting standards in the “5 star” program receive a higher reimbursement rate. This has resulted in colorectal cancer screening rates among plans in the 5 Star program to be consistently above 80%.

Currently, for Medicaid patients, there are QPM’s for breast and cervical cancer, but not colorectal cancer.  Medicaid plans are not required to report screening data and there is a huge discrepancy in screening rates between Medicare and Medicaid, with Medicare at 72% and Medicaid at 46%. Medicaid patients are 50% more likely to report with late-stage colorectal cancer and die from it than patients with commercial or Medicare coverage.

The Colorectal Cancer Alliance joined with other members of the National Colorectal Cancer Roundtable to advocate that the Centers for Medicare and Medicaid Services (CMS) establish QPM’s for the Medicaid population. This month, the advisory group responsible for recommending QPM’s for 2022 met and voted unanimously to add colorectal cancer screening as a quality measure for Medicaid. There will be a draft report of the QPM’s in July and a final report by August for implementation next year.

The Alliance sees this as an important step in improving the screening rate among adults 50 to 64, a group among which the rate of colorectal cancer is increasing compared to adults 65 and over, which is on the decline.


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