SHRM26 Debrief · Health & Wellness · #3771

The Screening Your Employees Are Skipping: An Employer's Playbook to Fix It

with Melanie Hardin

& Dr. Jordan Karlitz

& Cheryl Murphy

▶ Watch on the SHRM portal ~69 min, distilled

colorectal cancer screeningCologuardemployer wellness programs

"The main challenge is the first Cologuard. If you can get someone to do it once, then they're golden."

What it was about

Employers can meaningfully close the colorectal cancer screening gap by running employer-partnered, opt-out at-home stool test (Cologuard) campaigns with built-in navigation, at no upfront cost, reaching disengaged employees the healthcare system misses.

By the numbers

91% five-year survival / ~$110,000 cost of care

stage one colorectal cancer diagnosis

13% five-year survival / ~$255,000 cost of care

stage four colorectal cancer diagnosis

three out of four

colorectal cancer deaths occurring in people not up to date with screening

Key notes

Run colorectal cancer screening as an opt-out campaign rather than opt-in, since most employees simply don't read opt-in communications; Hillsborough County saw only a 3% opt-out rate.
Partner with a TPA or health plan to draw an eligibility file (age 45+, risk-excluded via ICD codes) so the employer never has to handle PHI directly.
Structure the program as claims-based with no vendor agreement or upfront cost to the employer or health plan; billing only occurs when a kit is returned and processed.

The contrarian takeOpt-out enrollment outperforms opt-in for employee health screening participation because most employees never read opt-in notices. And despite heavy TV marketing, colorectal cancer blood tests are inferior to stool-based tests like Cologuard, because they rarely detect polyps or early-stage (stage 1) cancer.

Take this back Monday

Do this for your team

Ask your TPA for an opt-out (not opt-in) Cologuard mailing to employees 45+, so most people don't have to lift a finger.

Say this in your next leadership meeting

Opt-out colorectal screening campaigns beat opt-in every time because employees just don't read opt-in emails — Hillsborough County got only a 3% opt-out rate.

Watch out for

Relying only on opt-in enrollment, which drastically undercounts participation because employees don't read or respond to opt-in notices.
Sending a single communication and assuming it's enough; adoption requires repeated messaging ("marketing 101" — people need to hear something multiple times).
Letting a positive at-home test result be treated as a diagnostic (billable/out-of-pocket) colonoscopy trigger, which discourages follow-through and was previously linked to costly billing surprises.

Fun fact · Dr. Jordan Karlitz

He founded and directed Louisiana's first hereditary GI cancer and genetics program, after training at Berkeley, McGill, Columbia, and Einstein.

If this landed, see these

↳ Go deeperThe Brain-Healthy Workplace: A New Imperative for HR LeadersSame low-cost, proactive-health lever, aimed at a different underdiagnosed risk: brain health.⇄ The counterpointManaging Stress & Increasing Recovery to Maintain Peak PerformanceComplicates the structural fix: engagement might need personal-awareness skills, not just defaults.✦ The unexpected oneRaid Readiness: Preparing Your Workforce for ICE Worksite ActionsSame pre-set-default instinct, aimed at ICE encounters instead of cancer screening.