A new study published in JAMA Oncology offers strong real-world evidence that initiating colorectal cancer (CRC) screening with fecal immunochemical tests (FIT) between ages 40 and 49 can significantly reduce long-term cancer incidence and mortality. While this may seem outside the immediate scope of Medicare-focused Accountable Care Organizations (ACOs), the implications for preventive care strategy and long-term risk management are highly relevant.
In the study, individuals who began FIT screening before age 50 saw a 25% reduction in CRC incidence and a 34% reduction in CRC mortality over a 17-year period compared with those who began at age 50. These long-term benefits extended well into the age groups most commonly served by ACOs—particularly those in their 60s and early 70s.
Current CMS Policy on CRC Screening Coverage
It’s important to note that, under current CMS guidelines, FIT screening is covered annually starting at age 50. While blood-based CRC screening tests are approved starting at age 45, FIT coverage has not yet been expanded to include individuals younger than 50. This distinction matters for ACOs because any strategy involving FIT for individuals under 50 must be aligned with coverage and reimbursement realities.
Still, this study provides a valuable opportunity for ACOs to consider how earlier engagement in screening—either through commercial coverage prior to Medicare enrollment or through aligned care models—can influence risk at the point of entry into Medicare.
Relevance for ACOs and Longitudinal Risk Management
For Medicare ACOs, the most actionable insight from this research lies in understanding which patients are entering their attributed population with a strong history of consistent screening—and which are not.
Key takeaways for Medicare ACOs include:
- Patients who have consistently participated in CRC screening before age 65 are far less likely to require high-cost cancer interventions during their Medicare years.
- The study reinforces the importance of ensuring screening adherence, particularly among beneficiaries in their early Medicare years, where risk from missed earlier screening may be highest.
- While FIT remains age-restricted under CMS policy, ACOs can use this data to identify and manage patients with gaps in CRC screening history and target them for immediate outreach.
Advanced Management USA, LLC’s Role in Supporting CRC Screening Quality
At Advanced Management USA, LLC, we work with ACOs to optimize screening workflows, address gaps in care history, and align clinical documentation with CMS quality measure requirements. Our support includes:
- Identifying attributed patients with incomplete CRC screening documentation
- Facilitating follow-up workflows when FIT or colonoscopy is due or overdue
- Helping provider organizations understand how screening history impacts risk adjustment and MSSP quality performance
By focusing on screening continuity and documentation, ACOs can improve care delivery while ensuring compliance with current coverage standards.
Bridging the Evidence and the Policy
This study does not suggest a shift in current Medicare coverage, but it strengthens the case for a policy evolution in the future. As CRC rates rise among younger adults, and as more commercial plans expand coverage for earlier screening, Medicare ACOs will increasingly encounter new beneficiaries whose risk profiles and preventive histories reflect these trends.
Until CMS coverage policies catch up with the latest evidence, ACOs can still act on this data—by identifying patients with poor screening histories, prioritizing CRC screening adherence, and closing care gaps that directly impact cost, quality, and outcomes.
Advanced Management USA, LLC remains committed to helping ACOs navigate these shifts thoughtfully, aligning evidence, policy, and clinical execution to support long-term success in value-based care.
Citation: Chiu, H.-M. et al. (2025). Long-Term Effectiveness Associated With Fecal Immunochemical Testing for Early-Age Screening. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2025.1433
