Objectives Participants will be able to:

Identify the characteristics of their local uninsured population over 50 years of age

Arrange primary care screening for those over 50 in most need of a screening colonoscopy

Develop a program to approach vendors and ancillary services for their support and services

Understand the need to promote the program for volunteer staff, ancillary services and sponsors in order to follow through on any findings

Facts versus FictionFact: Colorectal Cancer is the number 2 cancer

killer in the United StatesOne in every four adults, age 50-64, lack

adequate health insurance or does without health insurance.

Misconception: uninsured = unemployedIn 2005, 14% of 50-64 age group were retired and

uninsured, 23% were unemployedMajority of uninsured were self-employed or

worked for small employers 26% were self-employed 30% worked for employers with less than 25 employees

AARP Public Policy Institute, May 2007

Income of UninsuredOne in five lived in families with income below

federal poverty level (12,830/yr for family of two) in 2005

>Two in five had income <16,038 for family of two which is 200% of poverty level

An even higher proportion of retirees were below the poverty level, 27% at poverty level, 51% <16,038 for family of two

One-third of those 50-64 were above poverty level, but with income less that 20,000

AARP Public Policy Institute, May 2007

Out-of-Pocket Health ExpensesUninsured, ages 50-64, spend an

average of $915 per yearThis is 2.5 to 4 times higher than for the

younger uninsuredIncome usually increases with age, but

can flatten in the decade before age 65 due to disability or early retirement

AARP Public Policy Institute, May 2007

Other FactsOf the uninsured age 50-64

40% are in very good or excellent health21% report fair to poor health

Versus their insured peers53% report excellent or very good health18% report fair or poor health

Health spending burden of underinsuredRoughly 28% with or without coverage are

underinsured which falls highest among the poor or low incomes

AARP Public Policy Institute, May 2007

Recession FactsNumber of uninsured jumped nearly 3 million in

2009CDC reports in 2009, 46.3 million U.S. adults

lacked health insurance. This equals to one in five working age adults.

Texas is the worst with 24.6% of population uninsured

“In the U.S., health insurance means access to health care” CDC

Uninsured are less likely to get preventative care and often delay care until condition is serious.

Since 2007 insurance with high deductibles discourage preventative care.

Steven Reinberg, HealthDay News for Healthier Living, June 2010

CDC Colorectal Cancer Control ProgramEstimated 142,570 new cases in 2010 with 51,370

deaths from CRCSuccessful screening results: Now more than 1 million

survivors of colorectal cancer in the United States80 million baby boomers are set to retire and 91% of

new CRC cases occur in this age groupProgram’s goal is to increase screening rates of

individuals over 50 through education and screeningThese are tailored for low-income, uninsured and

underinsured individuals aged 50-64AGA supports this program and is requesting that

Congress continue to support the CDC’s programming

American Cancer Society, Cancer Facts and Figures 2009

Communication BarrierSurvey focused on the uninsured to examine

disparities in colorectal cancer screeningResults show that the uninsured were 64% less

likely to be screened than the insuredProvider recommendation was the only

significant communication measure.Uninsured lacking a recommendation were

98.5% less likely to be screened than those with a recommendation

Getting StartedSet up your team – you will assign sections of

program to each team member Initial team decisions will include:

Determine how many colonoscopies you want to perform

How many volunteers will be neededGive yourself 2-3 months to set this upSet your dates – one for preps, one for

colonoscopy

Team AssignmentsVolunteers: This person will present plan to

physicians and employees. Ancillary Services: Anesthesia, pathology,

surgeons and hospital. Supplies: Determine needs and sourcesPatients: Identify and approach the source

Primary Care Providers for the uninsuredProgram: Set up flow of program,

promotional items, post-program advertising

VolunteersSet up meeting to present plan and need for

volunteersAnnounce both datesPost sign up sheets for specific tasks to be done

Registration and discharge on both dates History, set up charts on prep date Colon prep instructionsDispense prep kit and t-shirts (our plan)Pre-op, post-op staff, follow up callPhysician, assistant and anesthesia

Ancillary ServicesExplain the plan to each one personallyAnesthesia: Line up volunteers for each suite

being clear about how many patients they will seePathology: Ask your primary lab to process

biopsies at no charge. Work to prevent charges to patient

Surgeons: Have a back-up for complicationsHospital: Get your hospitals on board to provide

services if neededInform these providers of any advertising or

promotional credit they may receive

SuppliesTake note of all necessary supplies and costs,

using daily usage as source Ask pharmaceutical vendors for donated prep

kits Ask equipment vendors for donated forceps,

snares, etc. or replacement for those usedDecide on main sedation and any back up –

approach supplier or plan to donate from your supplies

Patient SourceContact and meet with the PCP’s who provide

care to uninsured patientsDivide available screenings among themAsk for patients 50 years and older with no

symptoms, no previous colonoscopy, keeping this a screening colonoscopy

Arrange for advance receipt demographic sheets

Provide your required forms to be filled out and brought to first visit

Prepare for language and literacy barriers

Program PromotionMeet with volunteers to answer questions

and set up plan for smooth flow of patientsGet sizes and order T-shirts with

vendor/donor logos on back and theme on front, as gift to volunteers and patients. Have everyone wear on day of colon. This will increase the bond of all involved

Keep communications going among teamsRefreshments for patients

Give CreditMarketing to contact media for coverage on

day of colonoscopy, no advertisement prior to this

Publish a big thank you to all participantsFollow up with a media impact reportChallenge others to step up – In April 2010

the Tri-Cities Gastroenterology Group partnered with free clinics for a similar program

Our ResultsOur goal was to perform 50 screening

colonoscopiesEach patient received premium care from our

staff48 of the 50 selected patients followed

through with the screeningNine physicians performed 48 colonoscopies

one Saturday morning into early afternoon25 of the 48 patients had polyps removed

eliminating them as a risk for colorectal cancer