2. 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

3. Facts versus Fiction Fact: Colorectal Cancer is the number 2 cancer killer in the United States One in every four adults, age 50-64, lack adequate health insurance or does without health insurance. Misconception: uninsured = unemployed In 2005, 14% of 50-64 age group were retired and uninsured, 23% were unemployed Majority 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

4. Income of Uninsured One 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

5. Out-of-Pocket Health Expenses Uninsured, ages 50-64, spend an average of $915 per year This is 2.5 to 4 times higher than for the younger uninsured Income 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

6. Other Facts Of the uninsured age 50-64 40% are in very good or excellent health 21% report fair to poor health Versus their insured peers 53% report excellent or very good health 18% report fair or poor health Health spending burden of underinsured Roughly 28% with or without coverage are underinsured which falls highest among the poor or low incomes AARP Public Policy Institute, May 2007

7. Recession Facts Number of uninsured jumped nearly 3 million in 2009 CDC 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

8. CDC Colorectal Cancer Control Program Estimated 142,570 new cases in 2010 with 51,370 deaths from CRC Successful screening results: Now more than 1 million survivors of colorectal cancer in the United States 80 million baby boomers are set to retire and 91% of new CRC cases occur in this age group Program’s goal is to increase screening rates of individuals over 50 through education and screening These are tailored for low-income, uninsured and underinsured individuals aged 50-64 AGA supports this program and is requesting that Congress continue to support the CDC’s programming American Cancer Society, Cancer Facts and Figures 2009

9. Communication Barrier Survey focused on the uninsured to examine disparities in colorectal cancer screening Results show that the uninsured were 64% less likely to be screened than the insured Provider recommendation was the only significant communication measure. Uninsured lacking a recommendation were 98.5% less likely to be screened than those with a recommendation

10. Getting Started Set 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 needed Give yourself 2-3 months to set this up Set your dates – one for preps, one for colonoscopy

11. Team Assignments Volunteers: This person will present plan to physicians and employees. Ancillary Services: Anesthesia, pathology, surgeons and hospital. Supplies: Determine needs and sources Patients: Identify and approach the source Primary Care Providers for the uninsured Program: Set up flow of program, promotional items, post-program advertising

12. Volunteers

13. Set up meeting to present plan and need for volunteers Announce both dates Post sign up sheets for specific tasks to be done Registration and discharge on both dates History, set up charts on prep date Colon prep instructions Dispense prep kit and t-shirts (our plan) Pre-op, post-op staff, follow up call Physician, assistant and anesthesia

14. Ancillary Services Explain the plan to each one personally Anesthesia: Line up volunteers for each suite being clear about how many patients they will see Pathology: Ask your primary lab to process biopsies at no charge. Work to prevent charges to patient Surgeons: Have a back-up for complications Hospital: Get your hospitals on board to provide services if needed Inform these providers of any advertising or promotional credit they may receive

15. Supplies

16. Take 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 used Decide on main sedation and any back up – approach supplier or plan to donate from your supplies

17. Primary Care Providers

18. Patient Source Contact and meet with the PCP’s who provide care to uninsured patients Divide available screenings among them Ask 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

19. Program Promotion Meet with volunteers to answer questions and set up plan for smooth flow of patients Get 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 teams Refreshments for patients

21. Give Credit Marketing to contact media for coverage on day of colonoscopy, no advertisement prior to this Publish a big thank you to all participants Follow up with a media impact report Challenge others to step up – In April 2010 the Tri- Cities Gastroenterology Group partnered with free clinics for a similar program

22. Our Results Our goal was to perform 50 screening colonoscopies Each patient received premium care from our staff 48 of the 50 selected patients followed through with the screening Nine physicians performed 48 colonoscopies one Saturday morning into early afternoon 25 of the 48 patients had polyps removed eliminating them as a risk for colorectal cancer

24. The End?? NO WAY! We did it again 10/09/10