Local collaboration improves breast cancer screening rates in Cowlitz County

Breast cancer claims the lives of 42,000 people in the U.S. each year.¹ However, screenings keep this number from increasing. Breast cancer screenings (BCS) performed every two years reduce mortality rates by 26% for patients ages 50 to 74.²

Although screenings are crucial to reducing mortality rates, people living in rural settings are less likely to get this medical procedure done. Rural residents are more likely to face high levels of poverty, lower levels of education and lack of access to insurance and health care resources.³ Those with lower income encounter barriers such as cost of transportation, prevention resources and treatment.² People of color living in rural areas face further barriers, with people who are African American and Native American receiving fewer breast cancer screenings than those who are white.⁴

Cowlitz, a rural county in Washington, has a population of 111,956.⁵ Barriers to breast cancer screenings specific to Cowlitz residents include low provider availability, issues of transportation and limited availability for weekday appointments due to long distances between residents’ homes and the clinic. 

To address this gap in care, UnitedHealthcare Community Plan of Washington collaborated with the Cowlitz Family Health Center, a local federally qualified health center, and PeaceHealth St. John Medical Center, a screening provider, to identify ways to improve screening rates for people in the community. The screening program aims to improve BCS rates for residents as well as Cowlitz Family Health Center’s HEDIS® compliance rate by targeting barriers to access and social drivers of health.

Research shows that outreach clinics have been found to reduce patient travel burden and increase access to specialized care for rural communities.⁶ As a result, the program was designed with new engagement methods to improve screening rates and workflows to shorten existing delays in diagnostic follow-up. Since the onset of this program in 2022, year-end BCS rates have increased from 36% to 51% among the target population. The new workflow has also decreased the timeframe between screening appointments and follow-up diagnostic mammograms from one month down to two business days through improved collaboration between Cowlitz Family Health Center and PeaceHealth St. John Medical Center.

Each of the three organizations plays a significant role in achieving program goals. Within the outlined workflow:

• PeaceHealth St. John Medical Center sends the Cowlitz Family Health Center an outreach list based on their records of people who are in target population based on their age, location and date of their most recent mammogram.
• The Cowlitz Family Health Center and UnitedHealthcare Community Plan of Washington update the list to identify members still in need of a mammogram.
• PeaceHealth St. John Medical Center coordinators reach out to individuals on the updated list using revised engagement methods and scripts.
• For individuals in the target audience who turn down a screening appointment, the team makes a note. This creates the opportunity for the individual’s primary care provider to discuss the importance of screening and address any hesitancies or misconceptions.
• All three organizations meet every six weeks to discuss updates, challenges and action plans.

Outreach efforts are additionally focused on improving BCS access for people of color. Although this population makes up a relatively small percentage of the Cowlitz community, people of color experience a higher mortality rate from breast cancer and are more likely to have a late-stage diagnosis and hesitancies around seeking care. Improving outreach efforts for people of color is crucial to closing disparities in access to care and health outcomes. 

The BCS initiative aims to improve its work process and encourages feedback from stakeholders and patients. In response to feedback from individuals who were not available for weekday appointments, PeaceHealth St. John Medical Center is offering three Saturday mammogram clinics this fall. Cowlitz Family Health Center will be assisting with transportation services for these events.

UnitedHealthcare Community Plan of Washington is committed to innovative, collaborative, and community-led solutions that advance health equity and improve access to care for people in rural communities. Together, UnitedHealthcare Community Plan of Washington, Cowlitz Family Health Center and PeaceHealth St. John Medical Center are closing gaps in care with potentially life-saving screenings.