An HSREP initiative in development

Prevention Adoption Initiative

From evidence and advocacy to completed preventive care. The initiative translates HSREP’s central argument into an applied program: closing the gap between the preventive services America already recommends and the care people actually complete.

Problem framework: The Prevention Adoption Gap

The problem

The Prevention Adoption Gap

The United States loses lives and money every year to a problem that is behavioral rather than medical: people do not complete the preventive services that already exist and are already recommended. The screenings work. The guidelines exist. Completion is what fails, in how services are designed, communicated, and made accessible.

8.5%

of U.S. adults 35+ receive all recommended high-priority preventive services (Healthy People 2030, AHS‑08)

63.5%

colorectal cancer screening in 2023, against a 72.8% national target (objective C‑07)

$47T

projected U.S. cost of chronic disease over 15 years (Partnership to Fight Chronic Disease)

↓ Post-2020

eligible adults significantly less likely to complete cancer screenings than in 2019, with the largest declines among minority groups (JAMA Health Forum, 2024)

The proposed intervention

Three strategic pillars

The initiative packages commercial behavioral design (behavioral science, health communication, service design, and digital systems configured as intervention infrastructure) into a replicable toolkit a health system, FQHC, or health department can adopt, run, and sustain.

PILLAR 01

Service redesign & behavioral friction reduction

Reorganize how preventive screenings are packaged, communicated, and delivered so the easiest path is the completed one, defaults, simplified access, and barrier removal.

PILLAR 02

Data infrastructure as intervention

Dashboards and engagement protocols that surface who is overdue, where patients drop out of preventive pathways, and which outreach recovers them, built on common health-data standards.

PILLAR 03

Implementation enablement

Training, guides, and a structured onboarding pathway so frontline teams can run and sustain the toolkit without depending on its author, the pillar that makes the first two stick.

How it works, the behavioral loop

Identify

Flag patients overdue for a target screening from existing records.

Reduce friction

Offer the lowest-friction completion path as the default, e.g., a mailed at-home test.

Communicate

Reminders tailored by language and health-literacy level.

Escalate

Unanswered reminders trigger community-health-worker outreach.

Measure & learn

Every step is logged so the site sees where patients drop off, and refines the sequence.

Every lever (patient reminders, reducing structural barriers, mailed-test outreach, community health workers) is an intervention recommended by the CDC Community Preventive Services Task Force for increasing cancer screening.

First demonstration

Colorectal Cancer Screening Completion Pilot

One disease state, one population, one site, one primary outcome, deliberately constrained so the result is clean and attributable. A 12-month pilot at a Southeast Michigan safety-net provider, raising colorectal cancer screening completion among adults 45-75 who are due or overdue, measured against the site’s own baseline and evaluated with the RE‑AIM framework.

Phase 0 · Months 1-3

Site partnership

Recruit one Wayne or Washtenaw County safety-net site; sign an MOU with locked outcome definitions before anything launches.

Phase 1 · Months 4-15

Controlled beta

Run the behavioral loop within the site’s existing staffing; measure the absolute change in screening completion, cost per additional completed screening, and what recovered each patient.

Phase 2 · Year 2

Productize & replicate

Codify the validated workflow into version 1.0; publish peer-reviewed results; replicate at a second site to prove the toolkit transfers.

Phase 3 · Year 3

Scale through existing pipelines

Distribute through the training and technical-assistance infrastructure that already reaches 1,400+ HRSA-funded community health centers, and through NACCHO, ASTHO, APHA, and SOPHE networks.

Why institutions adopt it

It improves a number sites already report, and are paid on

HRSA UDSColorectal screening is a clinical quality measure every Health Center Program awardee reports annually (Table 6B), with public recognition for high performers.

Healthy People 2030Directly advances objectives AHS‑08, C‑07, and C‑09.

Medicaid value-based paymentMichigan’s HEDIS-based incentives attach financial consequences to the same screening measure.

CDC standardsCommunity Guide-recommended levers; standards-based (HL7® FHIR®) data exchange aligned with the CDC Public Health Data Strategy.

Status and limitations. The Prevention Adoption Initiative is in development. The methodology is defined, the product architecture is specified, and the pilot design is fixed, but the pilot has not yet begun, and all operational designs are illustrative specifications, not records of a deployed system. The initiative does not replace clinical decision-making and does not claim to fix access problems outside the adoption pathway, such as insurance coverage or provider supply. It does one thing well: convert eligible-but-unscreened patients into completed preventive care.

Partner on the first demonstration.

HSREP is seeking one Southeast Michigan safety-net partner site, professional feedback from APHA and SOPHE colleagues, and introductions to organizations working on preventive-care completion.

Start a conversation

MD Shafaat Ali Choyon, MCIM, MBA, MPH, CHES®

Initiative lead, a public health professional and former business strategist with more than 16 years of cross-sector experience, including direct healthcare leadership in screening-service redesign and clinical data infrastructure.