Exact Sciences (EXAS) Confirms Inclusion of Cologuard in HEDIS Quality Measures

October 3, 2016 12:36 PM EDT

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Exact Sciences Corp. (Nasdaq: EXAS) today announced that CologuardĀ® is now included in the 2017 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for colorectal cancer screening. The new quality measures were published by the National Committee for Quality Assurance (NCQA). More than 90 percent of America's health plans measure quality based on HEDIS.

"Cologuard's inclusion in the preeminent quality measures and its standing as an A-graded service in a leading screening guideline are critical steps toward becoming a standard of care for colon cancer screening," said Kevin Conroy, chairman and CEO of Exact Sciences. "Quality measures rate health care providers, systems and payers on metrics, including colon cancer screening compliance and patient satisfaction. These quality scores influence the level of reimbursement providers receive under value-based health care structures. Providers can now receive quality credit when their patients are screened using Cologuard, and Exact Sciences' comprehensive compliance program encourages completion of screening following a physician's prescription."

The HEDIS quality measures promote evidence-based health care and quality service to patients by assessing the performance of health plans on multiple measures. Colorectal cancer screening compliance and patient satisfaction are two measures that are evaluated to generate an overall quality score. Cologuard continues to achieve a nearly 70-percent compliance rate1 and survey data shows that 88 percent of patients have a very positive experience2 using Cologuard and engaging Exact Sciences' compliance program. Conversely, colonoscopy and fecal blood testing compliance rates are typically much lower.

"Including Cologuard in HEDIS creates incentives for health plans and providers to adopt the test by helping them achieve compensation goals and establish marketing opportunities," Conroy said. "We also believe that because patients like using Cologuard, they are more likely to rate their experience with their prescribing health care provider favorably."

Cologuard's inclusion in HEDIS with a three-year interval provides payers, health systems, and providers quality credit for a three-year lookback period during HEDIS audits. The 2016 HEDIS audit will give credit for Cologuard tests completed beginning in 2014, when Cologuard received FDA approval and was made available to patients.

"The fact that Cologuard is now accounted for in your HEDIS measures is huge for health plans," said Troy Caraway, chief executive officer of Physicians Plus Insurance Corporation. "If one or two early-stage cancers are detected because more people have a Cologuard test, we are far ahead as a health plan."

"With Cologuard, the scientific evidence is there, the compliance service is there, and now it counts toward our colon cancer screening quality credit," said Anas Daghestani, M.D., CEO of Austin Regional Clinic (ARC) and medical director for ARC's Population Health and Clinical Quality. "Adopting a test like Cologuard allows me to push my screening rate for colon cancer very high, very quickly without investing a lot of internal resources."

The HEDIS measures directly impact the CMS Star Ratings, which use HEDIS as the primary data source to guide quality measures for Medicare Advantage plans. The public comment period for the 2018 Star Ratings is expected to be announced in November 2016. The updated Star Ratings are expected to be published in February 2017.

NCQA's update to the colorectal cancer screening measure aligns HEDIS with the preeminent colorectal cancer screening guidelines, including those of the U.S. Preventive Services Task Force, American Cancer Society, National Comprehensive Cancer Network and the American College of Gastroenterology.

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