Vans Increase Breast Ca Screening Rates

FORT LAUDERDALE, Fla--Why would members of a managed care groupwhose coverage includes mammography not take advantage of thebenefit? Focus groups, conducted last year by Sanus, the managedcare division of the New York Life Insurance Company, found thatthe answer was lack of access, said Candy J. Rudy, manager ofaccount services at New York Life/Sanus.

The company followed up on the finding by initiating a programto make it easier for its members to receive mammo-grams, includingthe use of mobile mammography screening vans.

In some cases, the focus group sessions found that women werereluctant to take off time from work, Ms. Rudy said at the secondannual conference of the Industries' Coalition Against Cancer.These women had missed work for office visits for routine gynecologiccare, including Pap smears, but hesitated to take off more timeto follow through on their referrals for mammography.

Other women said that they did not want their insurance companyto know about the screening or that they did not want their employerto know.

To solve these problems, Ms. Rudy said, Sanus contracted withvendors to provide mammograms to its members without referrals."The member makes the appointment herself directly with thehospital vendor, so she's not telling her employer and she's nottelling Sanus. The vendors bill Sanus directly," she said.

When a member calls for an appointment, the vendor asks a seriesof questions to make sure the woman is a candidate for screeningaccording to the American Cancer Society guidelines, Ms. Rudynoted.

She pointed out that the use of mobile vans reduces travel timeand time away from work, making the service more accessible. Amobile mammography program in the Dallas/Fort Worth area has provedso successful that a fifth, independent vendor has been addedto the original four hospital vendors.

"We are booked some 2 to 3 months out," Ms. Rudy said.An advantage of independents, she added, is that they have moreflexibility in their hours, doing Saturday and late night screenings,and showing up for all work shifts.

On-Site Program in North Carolina

Kaiser Permanente, North Carolina, has used on-site mobile mammographyscreening for the past 2 years, said Michael T. Brohawn, of Kaiser'sGaston Medical Office, Gastonia, NC. Gaston County is the largestproducer of textiles in the country, he said, and many of the11,000 Kaiser Permanente members in the area work in the textilefactories.

"It is a high-risk population, in that 30% of the adult populationof the county has an 8th grade education or less . . . and thispopulation hasn't been inclined to seek out preventive healthcare in the past," he said.

Mr. Brohawn described the four-way partnership that has significantlyincreased mammography screening in the region--Pharr Yarns, atextile manufacturer whose employees include about 2,200 KaiserPermanente members; Metrolina Outreach Mammography, a mobile vancompany headed by Jean Griswold; Kaiser Permanente; and PresbyterianHospital, Charlotte, which interprets the mammograms.

Of 509 Pharr Yarns female employees aged 35 and over enrolledin Kaiser Permanente in 1994, 271 were screened, and three malignancieswere found, Mr. Brohawn said.

In North Carolina, Kaiser Per-manente's breast cancer screeningrate is 81%, which exceeds the Healthy People 2000 goal of 60%and Kaiser Perma-nente's program average of 69%. Mr. Brohawn hopesthat the mobile van program will further improve the rate in NorthCarolina.

He noted that the program includes an educational component, inthat employees are allowed to take 30 minutes off from work tolearn more about mammography screening.

He also emphasized the cost savings to the workers from on-sitescreening. "For members, there is no loss of income fromlost work, and that's significant for that population, since someof the textile companies still do not allow time off for sickleave. Second, there is no office copay, and third, there is notravel expense of going to the city for these services."

The program offers savings to the company as well, he said, interms of lower processing costs, since a referral is not required,and, ultimately, in reduced hospital costs from earlier interventions.