Mail-Based FIT Program Increases CRC Screening in a Value-Based Care System

Key Takeaways

• Slight improvement in patient participation in colorectal cancer (CRC) screenings: Out of the 3466 fecal immunochemical tests (FIT) successfully delivered, 465 (13.4%) were completed by patients. This is a small boost from the 7% FITs completed in the medical office.
• Recent patient engagement predicts screening completion: Patients who visited their providers within 18 months of receiving the FIT had a higher completion rate (15.9%) than patients who visited their providers more than 18 months prior (9.3%).
• Significant gap in screening completion and follow-up: Out of the 465 patients who completed the FIT, 45 (9.7%) had abnormal results. From this group, 11 patients (24.4%) followed up with diagnostic colonoscopies.
• Meaningful Value-Based Care (VBC) impact: This program led to a 1 STAR increase across 4 VBC programs.
• A large-scale system approach is possible but requires optimization: Some methods to further increase patient participation in CRC screenings and diagnostic colonoscopies include improved education of CRC and the importance of preventative screenings, stronger outreach strategies, and more accessible FITs.

Northwell Health implemented a system-wide health initiative to increase CRC screenings in patients between 45 and 75 years old. Mailing FITs to eligible patients saw a small but significant rise in patient participation in CRC prevention.

Low screening rates for CRC remain despite it being the third most diagnosed cancer in the US. Increasing preventative measures is a VBC goal aimed at improving patient care. According to the study’s authors, “The goal of assessing preventive measures, such as CRC screening, would be to identify CRC earlier and benefit from both the avoidance of greater healthcare utilization and better patient outcomes.”

Northwell Health used a mail-based FIT kit along with multiple follow-up reminders to increase screening completion. Of 3680 kits mailed between November and December 2023, 94.2% were successfully delivered. However, only 13.4% of recipients completed and returned the kits. While modest, this represents a meaningful improvement over prior internal efforts that yielded a 7% completion rate.

The study underscores the importance of patient engagement in driving screening adherence. Patients with a provider visit within the past 18 months were significantly more likely to complete testing (15.9% vs. 9.3%), highlighting a critical linkage between access to care and preventive service utilization.

Despite gains in screening, downstream care remains a concern. Among patients with abnormal FIT results (9.7%), just 24.4% completed a diagnostic colonoscopy. Of those who did undergo follow-up, 90% were found to have tubular adenomas, reinforcing the clinical value of early detection but also exposing a breakdown in care coordination.

Automated interactive voice response (IVR) calls and mailed educational materials were used to support patient engagement, though nearly half of completed kits were returned without successful phone contact—suggesting that passive outreach alone may not be sufficient. Proposed solutions include raising awareness of the dangers of CRC and the importance of screenings, implementing more strategic outreach methods, and incorporating FIT during regular patient visits.

From a payer perspective, the initiative produced notable financial and quality outcomes. The program contributed to a 1 STAR rating increase across 4 VBC plans—2 Medicare and 2 Medicaid. This improved STAR rating generated an estimated $1.4 million in pay-for-performance incentives on a $63 000 investment. These results highlight the potential return on investment for preventive screening programs aligned with VBC reimbursement models.

The results from this study, while indicating a small rise in CRC participation, show the program’s potential to improve patient outcomes. Optimizing the system could lead to a greater increase in patients undertaking specific preventative measures to avoid or reduce increased healthcare utilization.

Reference

Stathakos KM, Hon J, Palazzo L, et al. System-wide implementation of colorectal cancer screening in a value-based care setting. J Gen Intern Med. 2026;41:780-787. doi:10.1007/s11606-025-09706-0