How gap closure is reshaping preventive healthcare
Closing care gaps starts with meeting people where they are—and sometimes, that’s right at their front door.
In 2022, small white boxes began arriving on doorsteps in Florida.
The recipients were between the ages of 45 and 75, at average-risk for colorectal cancer, and were due or overdue for a colorectal cancer (CRC) screening. In the box? The Cologuard® test, a simple tool that uses an at-home sample collection kit for CRC screening.
Floridians receiving the kits were part of a program designed to “close the gap” in missed or overdue health screenings, an initiative sparked by Christopher R. Cogle, MD, an oncologist and professor of medicine at the University of Florida. Dr. Cogle created a new financial policy that encouraged Medicaid managed care plans to find ways to improve CRC screening rates in Florida. Proactively sending eligible enrollees a Cologuard kit was one of the methods deployed.
The impact was undeniable: in nine months, Florida Medicaid saw a 4.4 percent increase in CRC screenings overall.1
But perhaps a more meaningful shift? It happened in the lives of the people behind the data.
“The thing about these gap closure reports is that they are loaded not with people needing cancer screenings, they are loaded with people that need healthcare,” said Dr. Cogle. “In some cases, this cancer screening with Cologuard was the first healthcare encounter for these adults.”
These kinds of gap closure programs are changing the way preventive care reaches people. By identifying eligible people who are overdue for screenings and sending tests directly to their homes, often at no cost to them, they are removing barriers, reconnecting patients with providers, and in some cases, introducing people to healthcare for the very first time. And when it comes to CRC, specifically, that kind of access can be life-changing.
CRC is the second-leading cause of cancer death in the U.S.2, despite being one of the most preventable and treatable types of cancers3, especially when detected early.4 Yet, millions of Americans remain unscreened, which could be due to barriers like finding transportation, taking time off work, fear of procedures, or simply not knowing where to start.
Dr. Cogle’s initiative and use of the Cologuard test broke through some of those barriers and proved that a program that reaches patients in the most direct way possible has a real place in the future of healthcare.
What happens when Cologuard shows up at your door: Stephan’s story
Though not part of a gap closure program, Stephan, like many of the Floridians in Dr. Cogle’s program, was not expecting a Cologuard test to show up on his doorstep when it did.
Stephan is busy. A pilot, husband, father of four, as well as a foster father to one, his life is full to the brim in all the best ways.
“When I’m home, it’s baseball practices, baseball coaching, boy scouts, soccer, whatever the sport of the season is,” said Stephan.
Stephan is also very health conscious. Being able to show up for his family and their big, beautiful life is incredibly important to him. So, when his doctor began talking to him about screening for CRC, it wasn’t a question of ‘if,’ it was the ‘when’ that proved to be the tricky part.
Stephan and his doctor talked through screening options, including colonoscopy and the Cologuard test. But his insurance plan does not cover preventive care, so he told his doctor he would need to postpone screening while he looked into different avenues to bring down the cost. It wasn’t an ideal scenario, Stephan wanted to get screened, but given that he had no family history of CRC and no symptoms, he was willing to settle for that decision for the time being.
Shortly thereafter, a Cologuard test appeared on his doorstep.
“My doctor and I had talked about putting it off a few more years while I investigated getting a colonoscopy covered through the VA,” said Stephan. “But we must have gotten our wires crossed because about a month later, I got an email saying ‘your Cologuard kit is on its way.’ And there it was.”
Ultimately, Stephan was glad for the miscommunication.
“Cologuard takes all of the roadblocks and barriers to getting screened out of the picture,” said Stephan. “It’s accessible, it’s affordable, and I wouldn’t have to take time away from my family. It’s easy.”
After confirming with his doctor that the test was indeed meant for him, Stephan completed the test. His result was negative.
“This is the best kind of story to have, nothing remarkable,” Stephan said of his results. “I look at my health as something I’d rather know about now. I’d much rather find out about a problem early and fix it while it’s small than have to do a major fix later on.”
The big picture: Making prevention accessible
Stephan’s journey helps underscore the effectiveness of gap closure programs.
Like so many who are eligible for CRC screening, Stephan ran into barriers. Given his busy schedule and high out-of-pocket cost for colonoscopy, he very well may have gone several more years without screening had it not been for the Cologuard test’s serendipitous delivery to his home.
And while Stephan’s story has a happy ending (a negative result), others who are facing screening delays may not be as lucky.
According to the American Cancer Society, the five-year survival rate of distant CRC (late stage, spread to distant organs) is 13 percent.4 However, when caught early, CRC is highly treatable. It’s survivable in about 90 percent of cases.4
When it comes to CRC screening, on-time is best.
Timely screening that’s convenient might be even better.
“We’re seeing more young adults at risk,” said Dr. Cogle. “Our patients want relief of anxiety that they are not at risk of colon cancer.”
Dr. Cogle’s gap closure initiative proved that when patients are offered a convenient, non-invasive option to achieving that peace of mind, they are likely to act. Screening rates among individuals in Florida ages 45 to 55 saw a 7.3 percent bump, and among those ages 56 to 65, screening rates rose 4.2 percent.1
With the Cologuard test’s ability to detect 92 percent of all colon cancers, even in the early stages,5 that’s thousands of people who were able to receive critical information about their health.
“For many people, peace of mind is the most powerful driver of adherence,” said Dr. Cogle. “Convenience and reassurance, together, is what makes screening work at scale.”
The future looks a lot like gap closure
Those in the CRC space aren’t the only ones deploying programs like Dr. Cogle’s. Similar approaches—proactively reaching out patients who aren’t engaging with the healthcare system—are being used more frequently. These programs come in different shapes and sizes, with some anchored in digital outreach or community-based interventions, some featuring care directly to doorsteps.
For example, Mass General Brigham hospital has created a Healthcare at Home program, which brings comprehensive home-based care directly to patients in the form of remote monitoring, daily visits from clinicians, specialty consultations, and even meal services. Patients suffering from heart conditions, kidney disease, infections, and more have benefited from this program.6
To address hypertension, health systems like Yale New Haven Health and Boston Medical Center are implementing remote blood pressure monitoring combined with telehealth and community health worker support. These programs use cellular-enabled BP cuffs and team-based care to address hypertension disparities, especially in marginalized populations.7
Regardless of mode or medium, the sentiment remains the same: Efforts to close gaps in various healthcare sectors is the next frontier.
"The gap closure program is not only going to survive, it will thrive,” said Dr. Cogle.
Dr. Cogle’s trial run in Florida, and Stephan’s journey with the Cologuard test, make it clear: when care comes to you, more people say yes.
And when more people say yes, more lives can be saved.
Dr. Cogle was compensated by Exact Sciences in 2023 unrelated to this interview.
One of the patients featured in this story is the brother-in-law of an Exact Sciences employee.
References
1. Hall JM, Mkuu RS, Warren CO, Ghaffari B, Lurk PA, Cogle CR. Medicaid Payment Policy and Colorectal Cancer Screening Rates. JAMA Network Open. 2025;8(7):e2523271. Accessed August 20, 2025. https://doi.org/10.1001/jamanetworkopen.2025.23271
2. American Cancer Society. Key Statistics for Colorectal Cancer. American Cancer Society. Updated April 28, 2025. Accessed August 20, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html
3. Itzkowitz SH. Incremental Advances in Excremental Cancer Detection Tests. Journal of the National Cancer Institute. 2009;101(18):1225–1227. Accessed August 20, 2025. https://doi.org/10.1093/jnci/djp273
4. American Cancer Society. Survival Rates for Colorectal Cancer. American Cancer Society. Updated January 16, 2025. Accessed August 20, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html
5. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. New England Journal of Medicine. 2014;370(14):1287–1297. Accessed August 20, 2025. https://www.nejm.org/doi/full/10.1056/NEJMoa1311194
6. Mass General Brigham. Home Hospital. Mass General Brigham. Accessed August 20, 2025. https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/healthcare-at-home/home-hospital
7. Martin R. New Study Compares Approaches to Control High Blood Pressure. Yale School of Medicine. Published October 15, 2024. Accessed August 20, 2025. https://medicine.yale.edu/news-article/new-study-compares-approaches-to-control-high-blood-pressure/