Do Cash Incentives Improve CRC Screening Rates?

Use of a mailed reminder of colorectal cancer screening with or without a $25 cash card incentive was not effective at significantly increasing screening among two regions of New York State Medicaid Managed Care (MMC) patients, according to the results of a study published in Cancer.

In New York, about 6.1 million residents are covered by Medicaid, with 77% enrolled in the MMC. In 2015, the rate of colorectal cancer screening in the MMC population was 61%, lower than that for commercial health maintenance organization populations. Because of the high number of patients out of date on colorectal cancer screening, New York State Department of Health wanted to test methods to increase rates of screening.

In the study, Heather L.M. Dacus, DO, MPH, Bureau of Cancer Prevention and Control, New York State Department of Health, and colleagues randomly assigned patients aged 50–75 who were not up to date on colorectal cancer screening and lived in two regions to one of three cohorts. Patients received either no reminder of screening, a mailed reminder, or a mailed reminder with an incentive. The study included 7,123 people in the Adirondack Region (round 1) and 10,943 in the Central Region (round 2).

Five months after the mailed reminder send date, the screening prevalence in the Adirondack Region was 7.2% for the mailed reminder plus incentive group, 7.0% for the mailed reminder group, and 5.8% for the no reminder group. After 4 months, the screening prevalence was 7.2% for the mailed reminder in the Central Region and was 6.9% for patients with the mailed reminder plus incentive. Patients who got no reminder had a prevalence of 6.5%.

Overall, the researchers “observed no consistent positive motivation to undergo screening among those who were offered the $25 incentive.”

The cost of implementing this program was about 50% lower in the Central region than in the Adirondack region ($82,521 vs $176,005). According to the researchers, this decrease in cost is likely a reflection of “the procedures and lessons learned from the implementation of the interventions in round 1.”

The Department of Health has continued with this colorectal cancer screening campaign by dropping the no reminder group and editing patient and provider communications to “more strongly promote screening options.”

“We plan to evaluate the impact of these changes to the interventions and implement additional changes to further improve colorectal cancer screening uptake in these regions,” the researchers wrote.