What Payors Need to Know About Colorectal Cancer Biomarkers

Colorectal cancer (CRC) is a major health concern—the third most common cancer diagnosed in both men and women in the United States. For health plans aiming to improve patient outcomes and reduce costs, understanding the role of biomarkers in colorectal cancer is crucial. Biomarkers can not only aid in early detection but also guide treatment decisions, helping to tailor interventions to individual members’ needs.

What are biomarkers?

Biomarkers are biological molecules found in blood, other body fluids, or tissues that are a sign of a normal or abnormal process, or of a condition or disease. In the context of colorectal cancer, biomarkers can indicate the presence of cancer, predict how aggressive the disease may be, and guide decisions on the best treatment options.

Types of Colorectal Cancer Biomarkers

• Diagnostic Biomarkers: These biomarkers help in the early detection of CRC. For instance, the fecal immunochemical test (FIT) detects hidden blood in the stool, which can be an early sign of colorectal cancer.
• Prognostic Biomarkers: These indicate the likely course of the cancer. A commonly used prognostic biomarker is the Carcinoembryonic Antigen (CEA) level, which, when elevated, can indicate a more advanced stage of colorectal cancer.
• Predictive Biomarkers: These help predict how well a patient will respond to a particular treatment. For example, KRAS and NRAS gene mutations are predictive 

Schedule a time to chat with Ash Wellness about FIT screening to improve HEDIS scores. 

Why Biomarkers Matter to Health Plans

Utilizing biomarkers like FIT and stool DNA tests in screening programs can lead to early detection of CRC when it is most treatable, making early-stage cancer treatment less costly and more effective, and significantly reducing long-term healthcare expenses. Regular monitoring of biomarkers like CEA levels helps track disease progression and response to treatment, allowing for timely adjustments in therapy, which leads to better management of the disease and improved patient outcomes. Additionally, predictive biomarkers can identify patients unlikely to benefit from certain treatments, thus avoiding unnecessary side effects and costs associated with ineffective treatments.

The Role of FIT Testing in HEDIS Scores

The fecal immunochemical test (FIT) is a non-invasive test that detects hidden blood in the stool, an early indicator of colorectal cancer. Endorsed by many health organizations for its effectiveness, ease of use, and cost-efficiency, FIT testing can significantly improve HEDIS scores for health plans. Integrating FIT testing into colorectal cancer screening programs can see increased screening rates as the test offers a convenient, at-home option that requires no dietary restrictions and is less invasive than a colonoscopy. 

Additionally, FIT tests are more likely to be completed by patients compared to other screening methods, leading to higher compliance rates and more accurate reporting of screening rates, which positively impacts HEDIS scores. Furthermore, FIT tests are less expensive than other screening methods, such as colonoscopies, making them an attractive option for both patients and health plans. This cost-effective approach improves access to care, a critical component of HEDIS measures.

Learn about kit return rates and why they matter for health plans. 

‍How Ash Wellness Works with Health Plans

Ash Wellness is dedicated to helping health plans harness the benefits of at-home health testing to enhance member care and drive improved outcomes. With a comprehensive at-home testing solution and a focus on data security, privacy, and seamless integration, Ash Wellness stands as the ideal partner for health plans seeking to implement at-home health testing effectively. Our white-labeled FIT screening programs drive kit return rates to improve HEDIS scores. 

Conclusion

Biomarkers are transforming the landscape of colorectal cancer detection and treatment. Health plans can enhance early detection, personalize treatment, monitor disease progression, and reduce overall healthcare costs. Investing in biomarker testing not only aligns with the goals of improved patient outcomes and cost-efficiency, but also represents a proactive approach in the fight against colorectal cancer. Incorporating biomarkers into health plans is a strategic move that promises significant benefits for patients and the healthcare system as a whole.