Table 4.

Intervention-Specific Facilitators and Barriers for Implementation of Population-Based Colorectal Cancer Screening in Medicaid Health Plans in Washington State.

Population-based colorectal cancer program characteristics (intervention characteristics)	Number of plans citing	Example quotes
Facilitators
Strong business case	1	“An advantage of [using] the FIT test is that it costs [the plan] less up front than a colonoscopy and it delivers all its return on investment right away. The colonoscopy costs a lot more and then the financial benefits are actualized over a 10-year period.”—Health Plan 5
Ability to pilot prior to large-scale implementation	1	“We did a [pilot] of mailed FIT to a group of patients with a gap in care for colorectal cancer screening . . . It was really quite effective.”—Health Plan 5
Barriers
Unintended harms of population-based colorectal cancer screening programs	2	“One of my real concerns would be offering this service to members outside of a clinic visit creates missed opportunities for providers to see them. It might help rates of colorectal cancer screening, but would it end up lowering rates of other services that they normally get at a visit, like fewer mammograms being done or fewer flu shots being given? Because a lot of that stuff has to be done in the clinic. How can you mail people a flu shot . . .? We might be more likely to focus on getting people in for those preventive visits so that they can get all the preventive services they need and not just focusing all our attention on one service.”—Health Plan 1 “There could be problems with the lab vendor . . . You want to be sure that the lab is accurate. If they are having a way higher positive FIT rate, that could influence the number of colonoscopies needed. Patients getting unnecessary colonoscopies could also be harmed.”—Health Plan 4