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					            Addressing Colorectal Cancer Screening
            Disparities in Ethnic Populations
            R. Reid Kiser, MS
            National Director, Clinical Excellence
            UnitedHealthcare


            Jack Newsom, ScD
            Vice President, Analytics
            Silverlink Communications




1
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
    The Colorectal Cancer Screening Challenge




                                                       According to the                            Appropriate colorectal
                                                       National Cancer                             cancer screening often
    Colorectal cancer is the                         Institute, more than                            reveals a problem          Regular screening is a
    second leading cause                           145,000 new cases are                             before symptoms              critical preventive
       of cancer-related                            diagnosed and more                            occur, allowing for early      measure that saves
      mortality in the U.S.                        than 49,000 people die                         diagnosis and treatment                 lives
                                                   from this disease each
                                                              year                                                 .




2
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                            2
    Colorectal Cancer Screening Campaign
    Learning Objectives




    Understand the impact                         Understand how ethnic                                 Examine how
                                                                                                                                  HEDIS Impact and
        of interactive,                            specific messaging                                  engagement is
                                                                                                                                Return on Investment
      automated phone                              can impact screening                              influenced by the
                                                                                                                                for resource allocation
    outreach on colorectal                                 rates                                   gender of the voice in
    cancer screening rates                                                                            communications
                                                                                                          outreach




3
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                             3
    Colorectal Cancer Screening Campaign Approach




     1          2           3          4           5


1 2 3 4 5
     Members enrolled
    in communications
        received an
         interactive
      automated call
     between October
      26-November 5,
                                        Assignment of
                                            race and
                                        ethnicity based
                                       on data purchased
                                         from reputable
                                           third party.
                                                                              Analysis based on
                                                                                 claims data
                                                                              extracted for 2009
                                                                                    HEDIS
                                                                                 calculations.
                                                                                                                     Members were
                                                                                                                      determined to
                                                                                                                    have had a test if
                                                                                                                      there was no
                                                                                                                      evidence of:
                                                                                                                     colonoscopy,
                                                                                                                       fecal occult
                                                                                                                                          Overall 77.1% of
                                                                                                                                           those to whom
                                                                                                                                          communications
                                                                                                                                         were directed were
                                                                                                                                          HEDIS eligible at
                                                                                                                                         the end of the year
                                                                                                                                           and included in
        2009 plus a                                                                                                     blood test            analyses.
      follow-up letter                                                                                              (FOBT), flexible
     on November 17,                                                                                                sigmoidoscopy
            2009.                                                                                                       or double
                                                                                                                    contrast barium
                                                                                                                     enema (DCBE)
                                                                                                                         between
                                                                                                                   November 2, 2009
                                                                                                                   and December 31,
                                                                                                                          2009.



4
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                                  4
    Colorectal Cancer Screening Campaign
    Example Scripting



                                                                 Custom Messaging
                                                                Caucasian: And, despite colon
                                                                 cancer affecting so many people,
                                                                 only about 50% are getting
                                                                 screened for it.
                                                                Hispanic/Latino: And if you
                                                                 happen to be Hispanic or Latino,
                                                                 you’re part of a group that is least
                                                                 likely to have colon cancer
                                                                 screenings, compared with other
                                                                 ethnic groups.
                                                                African-American: And if you
                                                                 happen to be African American,
                                                                 you’re part of a group that only gets
                                                                 colon cancer screenings about 40%
                                                                 of the time.
                                                                Asian: And if you happen to be
                                                                 Asian-American, you’re part of a
                                                                 group that only gets colon cancer
                                                                 screenings about 34% of the time.




5
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.   5
 Call Engagement Correlates with
 Higher Screening Rates


             Colorectal Cancer Screening Rates for Those Who Listened to Message



                          10%
                          9%                                                                                                                        8.1%
                          8%                                                                                                    7.7%
                                                                                                  6.7%
             % Screened




                          7%                                        6.3%
                          6%          5.2%
                          5%
                          4%
                          3%
                          2%
                          1%
                          0%
                                Control Group                      Called  *                    Reached                     Authenticated   *   Listened to B2   *
                                 (Not Called)

                                                                                                                *Differences are significant at the 95%
             Source: UnitedHealthcare, Silverlink Communications 2010                                           confidence interval




6
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                                        6
 Colorectal Cancer Screening Campaign Hispanics



             Colorectal Cancer Screening Rates for Hispanics Who Listened to Message


                         15%
                                                                                                               11.4%             N = 45, 42, 48, 35
                                                                                       10.4%
                         10%
                                       6.7%
            % Screened




                                                               4.8%
                         5%



                         0%
                               Woman's voice x Ethnic Woman's voice x Standard   Man's voice x Ethnic   Man's voice x Standard
                                   message                  message                  Message                  Message




               Source: UnitedHealthcare, Silverlink Communications 2010




     Note: Excludes anyone taking the call in Spanish




7
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                         7
 Ethnic-Specific Messaging Impact



              Colorectal Cancer Screening Rates by Ethnicity
                                                                                                                            10.2% improvement with
                                                                                                                            ethnic message for Latinos

                         10%                       9.3%
                         9%            8.6%                                                                                     8.6%
                                                                                                                                        7.8%
                         8%
                         7%
            % Screened




                         6%                                                                   5.1%                                             Ethnic Message
                         5%                                                       4.4%
                         4%                                                                                                                    Standard Message
                         3%
                         2%
                         1%
                         0%
                                      African American                                 Asian                                       Latino




               Source: UnitedHealthcare, Silverlink Communications 2010




8
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                                     8
 Female vs. Male Voice Impact



              Colorectal Cancer Screening Rates by Ethnicity
                                                                                                                            89.4% improvement using the
                                                                                                                            male voice for Latinos


                         14%

                         12%                                                                                                                    10.8%
                                       10.2%
                         10%
            % Screened




                                                    7.8%                          8.0%        8.1%
                         8%                                                                                                                             Female Voice
                                                                                                                                5.7%
                         6%
                                                                                                                                                        Male Voice
                         4%

                         2%

                         0%
                                        African American                             Caucasian                                         Latino




               Source: UnitedHealthcare, Silverlink Communications 2010




9
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                                          9
 Colorectal Cancer Screening Barriers



                                                                                                                                                 Cultural diversity
                   Colorectal Cancer Screening Barriers                                                                                           can often be the
                                                                                                                                                  basis of barriers to
                                                                                                                                                  care.
                             45%         42%
                                               40%
                             40%   38%                                                                                                           Survey included
                                                     36%
                             35%                                             33%
                                                                                                                                                  ethnic-specific
                                                           31%                            30%   30%                                               messaging and
            % of Responses




                             30%
                                                                                                                             Caucasian            provided
                                                                 25%
                             25%                                       23%                        22%                        Asian                personalized
                                                                                    19%
                             20%                                                                                                                  barrier-breaking
                                                                                                                             Hispanic-Latino
                             15%
                                                                                                                                                  tips targeted to
                                                                                                        11%
                                                                                                                        9%
                                                                                                                             African American     the member.
                             10%                                                                                   8%

                             5%                                                                               4%


                             0%
                                    No Symptoms                    Cost               No Doctor               Afraid
                                                                                   Recommendation



                  Source: UnitedHealthcare, Silverlink Communications 2010




10
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  The Impact of Barrier-Breaking Messaging on
  Colorectal Cancer Screening




         Influencing the Resistant                                       Response to Barrier Tips                               Some Barriers Easier to Break

       Some people who said they                                       In general, African American                              Messaging tips for those who
       would not get a colon cancer                                     members were most likely to                               said they were afraid were
        screening actually did after                                    be screened after hearing                                most successful and tips for
           hearing the outreach.                                         the barrier breaking tips.                               those who said they had no
                                                                                                                                    symptoms were least
                                                                                                                                          successful.




11
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                                   11
 What’s Next for 2011 Programs and Beyond?



                                                                     1         Run campaign earlier in the year to increase HEDIS impact



                                                                     2         Determine ROI and prioritize budgets to where significant gaps may
                                                                               exist and there is a market specific need


                                                                     3         Next stage of custom messaging



                                                                     4         Apply to other HEDIS cancer screening measures



                                                                     5         Evaluate multiple contact points throughout each year




12
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                       12
        APPENDIX




 Confidential Property of UnitedHealth Group.
13
  HEDIS Colorectal Cancer Screening Outreach
  Communications History at UnitedHealthcare




                2006                                           2007                                          2008                    2009

          Added to annual                               Partnership with                                  Increased              Pilot testing with
           HEDIS Interim                               American Cancer                                 messaging for                 variable
             Reminder                                   Society mailer                               African Americans,         messaging based
             Mailings if                                                                               Hispanics and               on race and
          member qualified                                                                            Latinos in select           ethnicity data
          for other HEDIS                                                                                  markets
              measure




14
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                         14
  Differences in Colorectal Cancer
  by Ethnic Population


        All Races                                                                                                               Asian/Pacific Islander

       55.8 per 100,000 men                                                                                                     45.5 per 100,000 men

       41.7 per 100,000 women                                                                                                   34.2 per 100,000 women


        White                                                                                                                   American Indian
                                                                                                                                /Alaska Native
       55.4 per 100,000 men                                                                                                     43.4 per 100,000 men
       40.9 per 100,000 women                                                                                                   40.4 per 100,000 women


        African American                                                                                                        Hispanic

       68.1 per 100,000 men                                                                                                     44.5 per 100,000 men

       52.6 per 100,000 women                                                                                                   31.6 per 100,000 women



                                            Hispanic / Latino populations
                                           are least likely to be screened.
                                                                                                                                      Data from National Cancer Institute-2009

15
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  Colorectal Cancer Screening Campaign Overview




    In Fall 2009, Silverlink                          Members were                                   Impact of male vs.
                                                                                                                                         UHC provided claims
  launched calls to 59,423                           grouped by race/                                female voices was
                                                                                                                                          information for its
    commercial members                              ethnicity to test the                           tested where sample
                                                                                                                                         members to assess the
   who required colorectal                        impact of ethnic-specific                              size allowed
                                                                                                                                          ability of the call to
       cancer screening                            messaging compared                                                                     promote colorectal
                                                       with standard                                                                      cancer screenings
                                                        messaging




                    51+                                                                                                                    $
     Members had to be enrolled in                                     Members from two regions                                     Due to budgetary
      fully insured commercial                                         (Southeast, “National”) were                             constraints, not all eligible
      HMO/POS plans, be older                                           identified for interventions.                            “National” members were
     than 51 years old, and have                                                                                                          loaded.
      no evidence of colorectal
     screening in the previous two
                years.
16
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                                      16
  Colorectal Cancer Screening Campaign Testing




     Race/Ethnicity                              Test                                       Cell Size                           Region

     Caucasian                                   Communication                              31,511                              National, Southeast

                                                 No Communication                           12,209                              National, Southeast


      Race/Ethnicity                             Test                                       Cell Size                           Region

      Latino                                     Woman Voice x                              267                                 National
                                                 Ethnic-specific
                                                 Message
                                                 Woman Voice x                              232                                 National
                                                 Standard Message
                                                 Man Voice x Ethnic-                        235                                 National
                                                 specific Message
                                                 Man Voice x Standard                       251                                 National
                                                 Message


17
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                         17
 The Highest Percentage Of Screenings
 Came 5-6 Weeks After The Reminder Call



             Colorectal Cancer Screening Rates by Ethnicity


                                                         Thanksgiving for                                                           Christmas and
                                20%
                                                         most participants                              17.2%
                                                                                                                           17.8%      New Year

                                15%
              % of Screenings




                                      12.4%      12.3%                                12.3%
                                                                    10.4%                                                           10.2%
                                10%
                                                                                                                                              7.5%


                                5%


                                0%
                                        1           2                  3                 4                 5                    6     7        8
                                                                       # of Weeks between Last Call and Screening


             Source: UnitedHealthcare, Silverlink Communications 2010




18
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.                        18

				
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