One Minnesota clinic transcends a race barrier to good patient care

It doesn't matter if you are Black, white or other at Richfield Medical Clinic — you'll get screened for colorectal cancer when it's your time.

More than 70% of the clinic's eligible patients were screened in 2022, according to a new report on health care disparities by MN Community Measurement, including 73% of its Black patients. Statewide, only 52% of Black patients were screened as recommended last year through colonoscopies or mail-in tests, compared with 70% of white patients.

The disparity is troubling because Black Minnesotans are more likely to suffer from colon cancer and die from it, but the Richfield center's performance shows that a clinic can break through race barriers and help patients overcome discomfort with the screening. HealthPartners was the only other provider with a Black colorectal cancer screening rate at or above 60% last year.

Dr. Kevin Nelson said he has used humor with hesitant patients at his Richfield clinic, calling the screening a "colostomy bag prevention tactic" that can catch or prevent cancer before it requires invasive treatment. Personal relationships with patients go a long way, but he said his suburban clinic's results are boosted by its more affluent patient population.

"Socioeconomics is probably as important as anything," he said.

That rings true for Neighborhood Healthsource, which operates three clinics in low-income neighborhoods of north Minneapolis and one in Coon Rapids. More of its white patients are uninsured, which helps explain why their colon cancer screening rate of 27% was lower than the 34% rate for Black patients.

Patients with multiple jobs struggle to make time for physicals, much less go in for a colonoscopy or obtain a stool sample at home and mail it in, said Erika Denham, a community health worker for the federally qualified health center. Some clients have insurance but are worried that a mix-up will leave them with a $1,000 bill. Others, particularly first-timers, are repelled by the idea.

Neighborhood Healthsource responded by increasing from four to 22 the number of workers such as Denham. They review charts of scheduled patients each morning to see which ones are due for screenings, then meet with them after checkups.

Denham said she keeps her message simple, but that there is power in being "an African American woman kind of cosigning how important this is."

"Think about that mom working two or three jobs," she said. "She is putting herself on the back burner to survive. With the cost of living today and the cost of food today, sometimes your health is the last thing you are worried about."

Colorectal cancer screening is one of several clinical measures publicized by MN Community Measurement, a nonprofit dedicated to using data to boost the quality of health care in the state. Other measures include the percentage of patients with diabetes, vascular disease and asthma who are kept at optimal health.

No clinic scores perfectly. Richfield is better than most at managing diabetes, but worse at following up with patients about depression and helping them achieve remission.

Most clinics saw a decline in colorectal cancer screening rates for eligible patients in 2022, partly because federal guidance expanded its recommendation to patients age 45 to 49 at average risk. However, screening declined in the 50-and-older population as well, partly because of the COVID-19 pandemic, said Julie Sonier, chief executive of MN Community Measurement.

"Even the groups that have the most advantages, they're still struggling to get back to where we were," she said.

Most disparities remained as well, she added, although colon cancer screening rates improved for non-English speakers.

HealthPartners sent results to its doctors so they could evaluate their performance and consult with others who did better.

The organization has tried to build relationships with Somali and other minority communities so they are comfortable seeking preventive care. It also calls patients who are due for colorectal cancer screenings and mails home tests to them.

"Not everybody returns them, but anybody returning them is better than not having them returned at all," said Dr. Beth Averbeck, HealthPartners' senior medical director for primary care.

Many types of primary care suffered during the pandemic when HealthPartners diverted workers to COVID-19 testing and vaccination, she said. "We're recovering from that, but honestly it's taken us into 2023. That recovery wasn't all in 2022."