Early Detection and Prevention Committee

Why? Screening makes a difference in cancer incidence and mortality statistics.

The more people we screen, the better our chances that fewer people will develop the disease—or that we can find it sooner to successfully treat it. That philosophy—and the Cancer Screening Nurse Navigator program created to support it—made a difference in colon cancer. That’s why we’ve applied that same thinking to cervical, breast and prostate cancer. It’s especially important to reach the 40% to 50% of men in Delaware who have not been screened for prostate cancer. And the girls and young women who now can receive an FDA-approved HPV vaccine to help prevent cervical cancer. As with colon cancer, many of our medically underserved residents are unaware of the availability of affordable or free screenings.

SCREENINGS PERFORMED WITH NURSE NAVIGATOR ASSISTANCE
Comparison of FY 06 (7/05–6/06) to FY 07 (7/06–4/07)

ARE SOME OF US MORE LIKELY TO BE AFFECTED BY THIS THAN OTHERS?

Breast cancer mortality is higher in African Americans than in Caucasians.
Prostate cancer incidence rates for African Americans are higher than for Caucasians.
In the next five years, estimates indicate the percentage of the Delaware population
age 65+ with Part A Only Medicare (hospital only coverage) and who meet Screening for Life guidelines will grow.

WHAT CAN BE DONE

Laterally apply what we've learned with the colorectal Cancer Screening Nurse Navigator program to the other most prolific cancers-breast, cervical and prostate-to get people screened.
Reimburse providers for colorectal, prostate, breast and cervical cancer screenings who meet the appropriate guidelines.
Make sure that the targeted populations know about services available to them.
Provide a cervical cancer vaccine for girls and young women and educate them about it.
Bring more breast and cervical screenings-via mobile outreach-to targeted populations.
Remove barriers that keep people from getting screened by examining the impact of deductibles and co-pays on screening.

Click each goal to read about the objectives, tasks and timeframes.

Goal 1:

Enhance the Cancer Screening Nurse Navigator program to promote colorectal, prostate, breast and cervical cancer screening.

Year 1

$1,500,000

Year 2

$1,500,000

Year 3

$1,500,000

Year 4

$1,500,000

Objective 1A: Achieve an 85% colorectal cancer screening rate among Delawareans 50 and older, and 85% prostate screening rate in men 50–75 (or life expectancy of 10 years) and high-risk men starting at age 40.

Task/Action	Responsible Party	Timeframe
Fund Cancer Screening Nurse Navigator...	General Assembly	Year 1 & ongoing
Expand the scope of the current Cancer Screening Nurse Navigators to include prostate cancer and hire .50 FTE nurse at each site (as needed) to implement the program.	General Assembly	Year 1 & ongoing
Establish relationships with primary care providers and surgeons to increase screening of patients.	Navigators	Year 1 & ongoing
Establish relationships with state service centers and federally qualified health centers to increase screening referrals.	Navigators	Year 1 & ongoing
Increase the number of minorities receiving screenings.	Navigators & Champions of Change organizations	Year 1 & ongoing

Objective 1B: Inform and educate health care providers and general public on available resources.

Task/Action	Responsible Party	Timeframe
Promote campaign to public and businesses focusing on available resources.	DPH	Year 1 & ongoing
Provide updates to health care professionals through letters and personal outreach.	DPH, Navigators and Advocates	Year 1 & ongoing
Develop new and nurture existing relationships with Primary Care Physicians’ offices.	Navigators	Year 1 & ongoing

Objective 1C: Expand and modify current database used to track and evaluate Cancer Screening Nurse Navigator program.

Task/Action	Responsible Party	Timeframe
Modify database to include breast, cervical and prostate cancer screening.	DPH	Year 1
Enhance database tracking system for continued surveillance of patients diagnosed with cancer.	DPH	Year 1 & ongoing

Objective 1D: Increase types of reports available to Navigators and project administrator.

Task/Action	Responsible Party	Timeframe
Expand reports to allow for sorting, cross tabulation and reporting of screening results.	DPH	Year 1

Goal 2:

Reimburse colorectal, prostate, breast and cervical cancer screening for Delawareans who meet age and income eligibility guidelines.

Year 1

$640,400

Year 2

$800,000

Year 3

$900,000

Year 4

$1,000,000

Objective 2A: Continue annual allocation for colorectal cancer screening and breast and cervical cancer screening for womenineligible for federally funded screenings.

Task/Action	Responsible Party	Timeframe
Revise allocation based on actual costs and projections	General Assembly	Annually

Objective 2B: Add prostate cancer screening as a covered service under the state’s Screening for Life program.

Task/Action	Responsible Party	Timeframe
Establish an annual allocation for prostate cancer screening (DRE and PSA) for the uninsuredand underinsured and funding for further diagnostic testing required for follow-up.	General Assembly	Year 1
Revise allocation based on actual costs and projections.	General Assembly	Annually

Objective 2C: Add continued surveillance as a Screening for Life covered service for clients served through the Delaware Cancer Treatment Program.

Task/Action	Responsible Party	Timeframe
Determine acceptable surveillance procedures for coverage.	DCC	Year 1
Allocate annual allotment to SFL funding to cover surveillance procedures for patients diagnosedwith cancer who have income between 251% and 650% of the Federal Poverty Level.	General Assembly	Year 2
Revise allocation based on actual costs and projections.	General Assembly	Annually

Goal 3:

Provide HPV vaccine to girls and women ages 9 through 26.

Year 1

$800,000

Year 2

$450,000

Year 3

$200,000

Year 4

$75,000

Objective 3A: Conduct a targeted media campaign aimed at parents of girls 9–18 and young women ages 19–26 to educate about cervical cancer and the benefits of HPV vaccination.

Task/Action	Responsible Party	Timeframe
Use outlets such as television, radio and print media to educate and inform parents and young women.	DPH	Years 1–4

Objective 3B: Promote vaccination of girls 11–12 (priority population) through the use of incentives.

Task/Action	Responsible Party	Timeframe
Provide incentives for girls 11–12 who receive all 3 doses of HPV vaccine. (Note: Per 2006 estimate there are 10,886 girls in this age range.) Goal is to immunize 75% of target population—8,165.	DPH	Years 1–4

Objective 3C: Support Delaware’s Vaccines for Children (VFC) program infrastructure to increase the number of cliniciansproviding HPV vaccine and to appropriately monitor/track distribution of vaccine (note: VFC provides HPV vaccine for uninsuredand publicly insured girls 9–18 years old).

Task/Action	Responsible Party	Timeframe
New providers will be enrolled into the registry and provided with reporting forms to submit immunization records. Registry modifications will be made for the expanded provider base and to allow for entry of adult records.	DPH Immunization Program	Years 1–4

Objective 3D: Support an HPV campaign at primary and secondary schools to reach the target population of 11- to 12-year-olds and the “catch-up” group of 13- to 18-year-olds.

Task/Action	Responsible Party	Timeframe
Coordinate an HPV campaign with school administrators, school nurses and the immunizationprogram at DPH.	DPH, DOE	Years 1–4

Objective 3E: Fund HPV vaccine for Screening for Life (SFL) eligible women 19 through 26 years old.

Task/Action	Responsible Party	Timeframe
Reimburse participating providers at Medicaid rates for delivery of HPV vaccine to SFL-enrolled women 19–26 years old.	General Assembly, DPH Screening for Life	Year 1 & ongoing

Goal 4:

Expand Mobile Cancer Screening services to include cervical cancer screening in addition to mammography services.

Goal 5:

Study the impact of barriers to cancer screening and put in place programs/services to screen at-risk populations.

Year 1

Year 2

$TBD

Year 3

$TBD

Year 4

$TBD

Objective 5A: Study the impact of high deductibles on preventing colorectal cancer screening of privately insured Delawareans.

Task/Action	Responsible Party	Timeframe
Establish parameters of what constitutes a high deductible.	Early Detection and Prevention Committee	Year 2
Identify number of Delawareans privately insured with individual/small group plans.	DPH	Year 2
Determine to what extent a high deductible is a deterrent to seeking colorectal cancer screening.	DPH	Year 2
Present data to insurance companies on cost of covering screening vs. cost of colorectal cancer treatment.	Early Detection and Prevention Committee	Year 2

Objective 5B: If supported by the data, pay for CRC screening deductible and co-pay for low-income individuals with Medicare through Screening for Life.

Task/Action	Responsible Party	Timeframe
Establish eligibility criteria.	DPH & DCC	Year 3
Allocate annual allotment for colorectal cancer screening deductible and co-pay coverage for low-income Medicare recipients.	General Assembly & DCC	Year 3
Establish a system for billing and payment for colorectal cancer screenings to include co-pay and deductible whereby funds would be paid directly to health providers for reimbursable services based on Medicare rates.	DPH	Year 3
Education and outreach to low-income Medicare recipients.	Navigators & Champions of Change	Year 3 & ongoing
Revise allocation based on actual costs and projections.	General Assembly	Year 3 & ongoing

Objective 5C: Use claims data to provide targeted nurse navigation, referrals and scheduling assistance to interested clients.

Task/Action	Responsible Party	Timeframe
Compile list of those who have not received colorectal cancer screening and distribute list to physicians and Navigators for education, referrals and scheduling assistance.	DPH	Year 1