Well, good afternoon, everybody, and welcome to our webinar on colorectal cancer advocacy. I'm Dr. Angela McIlyde. I have the pleasure of serving as the Vice President for Programs and Education at the American College of Preventive Medicine. We're joined today by two outstanding professionals, Molly McDonald, who's the Director of Advocacy for Fight Colorectal Cancer, and Mr. James Gray, who is the Senior Government Relations Director in Texas for the American Cancer Society Action Network. I'd like to just spend a couple of minutes telling you about the American College of Preventive Medicine. ACPM is a professional medical society of approximately 2,000 physicians dedicated to improving the health and quality of life of individuals, families, communities, and whole populations through disease prevention and health promotion. We're based in Washington, D.C. Our members are licensed medical doctors who possess expertise in a broad range of healthcare skills, including biostatistics, epidemiology, the management of health organizations, research, and the practice of prevention in clinical settings. Our members work in hospitals, government at the local, state, and national levels, the military, laboratories, business, and academia. I have a few housekeeping items to share. The first is that as the audience has been placed in listen-only mode, we will be posting a recording of this webinar on the acpm.org website in just a day or two. So if you would like to share the webinar with your colleagues, please feel free to do so. We ask that throughout the presentation that you type your questions in the chat box, and we will address those towards the end of our session. And finally, we want to know what you thought and what we can do to, for future webinars. So please fill out the survey that you'll receive after the webinar is completed. It gives me great pleasure to introduce our two speakers today. Molly McDonald joined Fight Colorectal Cancer in October 2019 as the Director of Advocacy. Prior to coming on board full-time, Molly was a principal at the government relations firm Winning Strategies Washington, where she worked with clients from across the healthcare sector, including Fight CRC, to creatively tackle their most pressing policy and advocacy challenges. Having lost her great aunt to colorectal cancer, Fight CRC's mission has always been very close to her heart. Molly spent five and a half years working on Capitol Hill for Congressman Leonard Lance of New Jersey. She served as Congressman Lance's Senior Health Policy Advisor, working with such issues as medical research, public health, drug development, and healthcare coverage. Molly also supported the Congressman's work with the Deadliest Cancers Caucus, helping to educate, advocate, and develop public policies to improve the lives of patients suffering from cancer. Molly currently lives in Chicago, Illinois. Mr. James Gray is the Senior Government Relations Director in Texas for the American Cancer Society Cancer Action Network. He graduated from the University of New Hampshire with a BA in political science and obtained his MS degree in organizational leadership and ethics from St. Edward's University in Austin, Texas. James also completed a fellowship with the Advocacy Institute in Washington, D.C. He has been involved with public policy development for 25 years, with part of that time spent in government relations for a chamber of commerce. For the last 20 years, he has been leading advocacy efforts for the American Cancer Society's Cancer Action Network in both New England and in Texas. In this capacity, he has worked with elected officials at all levels of government to implement cancer-related policies that improve the prevention, detection, and treatment of cancer. James is the father of three girls and enjoys hiking, running, and collecting political memorabilia. So with that, I'll turn the podium over to Ms. McDonald. Thanks, Angela, and thank you to ACPM for having me today. I'm excited to be here to talk a little bit about fight colorectal cancer and our advocacy work. So if we could go to the next slide, that would be great. So for those of you not familiar, Fight Colorectal Cancer is a national patient advocacy organization dedicated to the colorectal cancer community, and we, you know, fight to cure colorectal cancer and all those affected by the disease through informed patient support, impactful policy change, and breakthrough research endeavors. Next slide, please. So today, I'm going to go over a couple of different topics in terms of our advocacy work. I'm going to start by briefly going over a couple of our federal policy priorities and then dig into our catalyst state-by-state advocacy program, and then we'll get to hear a little bit from James, who's one of our catalyst grantees, and then hopefully we'll have plenty of time for questions and discussion with the group. Next slide, please. Great. So on the federal level, I just wanted to quickly go over two of our top federal funding priorities. So many of you may be familiar with the CDC's Colorectal Cancer Control Program. This is a program that works with health systems to help increase colorectal cancer screening rates for those 45 to 75. So this is obviously incredibly important during any time, but particularly in light of COVID-19 and the impact that the pandemic has had on colorectal cancer screening. In particular, the Colorectal Cancer Screening Program focuses on high-need populations and works with grantees to implement evidence-based interventions that work to increase access to screening. So currently, the program funds 35 awards in 20 states, and as you can see, over the past several years, funding has been stagnant for the program. It's been, you know, the same for the past several fiscal years. In the most recent federal funding bill, there is a proposal to boost the funding by about $2 million, but if you've watched the news at all, you know that that process is a bit of a mess in D.C. right now, so we won't know for probably a couple of months here what the end result will be. But as you can hopefully see from this graphic on the screen, you know, awardees that have been involved with the program for four years have increased screening rates by over 12%. So that's a really great record, and the CDC has done a great job of, you know, really keeping great data on the program and just showing that it works, which is not something that you can say for all federal programs. So, you know, we think, again, particularly in light of COVID-19 and the need to make sure that folks are getting back on the books, it's more important now than ever that we increase funding for this program so that it can, even more states can benefit from this work. Next slide, please. So in kind of another bucket in terms of federal priorities, obviously the federal government is the largest funder of medical research, and so it's incredibly important that we make sure that colorectal cancer is prioritized. When most people think of medical research, they think of the National Institutes of Health and the National Cancer Institute, and that's certainly a really important venue where a lot of great research is being done, but there's also really great research being done through the Department of Defense. So the DOD has a program called the Congressionally Directed Medical Research Program, and within that there are a number of different programs, some of which are disease-specific, some are more kind of catch-all programs, and these programs really are kind of that high-risk, high-reward research. They're not duplicative of what's happening at NIH and NCI, but instead, you know, investing in these projects that are maybe a little more out there but have the potential to have a really high return on investment. So as you can see from this chart on the left, colorectal cancer is one of the, is the only cancer of the top five cancer killers not to have its own research program. Instead, it's eligible for funding through what's called the Peer-Reviewed Cancer Research Program. So we've been eligible for that program for about a decade, almost since it was created, and that program has anywhere between 15 to 20 different cancers that each year are competing for a limited amount of dollars. So we're, of course, grateful to, you know, have been included in that program, and as you can see in FY20, we received about $9 million for colorectal cancer research but we believe that it's long overdue that colorectal cancer get its own research program at the Department of Defense. So not only will this, of course, give a dedicated funding stream to colorectal cancer research, but it also comes with a really robust and dedicated strategic approach to the research. So the DoD goes through a process where they're bringing together stakeholders in the colorectal cancer community to understand where are the gaps, where are the opportunities, and what's sort of the best and highest use of those dollars. So this is a really high priority for fight colorectal cancer, and we're hoping that in the next year we'll be successful in creating this program. Next slide, please. So next I want to move on to our state advocacy work. So fight colorectal cancer, just by way of background, has been around for almost 15 years, and we have traditionally focused our efforts on federal advocacy. But around, about two years ago, around the time that I came on board, we decided that, you know, we have advocates from all across the country who are really active, and we wanted to be able to leverage that network and start to get involved in policy in the state level. Obviously, things at the federal level tend to move a bit more slowly, and things at the state level, you know, can happen really quickly, and there's just a lot of really important work being done at the state level. So we wanted to make sure that we were involved in that and could help to make sure that colorectal cancer is prioritized. So we created the Catalyst State-by-State Advocacy Program, and the purpose of the program and the aim of the program is really to support states that are working to advance policy and increase access to colorectal cancer screening. So when the program was created, our first kind of key priorities were around, you know, ensuring coverage for colorectal cancer screening beginning at age 45, which at the time, was just through American Cancer Society guidelines. But now, as of just a couple months ago, USPSTF followed suit, so we are really excited to see that. But many states have specific ages baked into their statutes, so it's been important work for us to make sure that those statutes are updated and reflect the most updated guidelines. And then the other part, our kind of other big priority has been around what we call the follow-up colonoscopy issue. So as I'm sure many of you know, colorectal cancer, we're very fortunate in that we have not just one effective screening modality, but multiple. So colonoscopy is, you know, obviously viewed as sort of the gold standard, but we also have several non-invasive screening options that are, you know, a great option for patients who, one, are at average risk, but are either hesitant or afraid or, you know, have any kind of number of issues that prevent them from going in for a colonoscopy. So this issue has obviously become, again, more important now than ever in light of COVID with many health clinics, certainly at the beginning of the pandemic, but now we've seen it more recently, too, shutting down their elective procedures and, you know, folks being hesitant to go in to their doctor's office. So this provides, you know, a great way for us to ensure that people are still keeping up to date on their screening. So the one kind of, oh, sorry, if we could go back, the one kind of caveat to that is if someone gets a positive result on one of these non-invasive screening tests, they need to have a colonoscopy to confirm their diagnosis. And unfortunately, what we're seeing for many patients is that there's significant out-of-pocket costs with that follow-up colonoscopy. So people either delay or don't get the colonoscopy at all, which obviously can lead to a later stage diagnosis when the disease is much more difficult to treat. So we really believe that that full kind of, that screening is not done until you get that follow-up colonoscopy, and so that full kind of process should be covered. And so Fight CRC provides grants of up to $50,000 to state coalitions who are looking to engage in this work. Most of our states have worked on some combination of these two issues, but also, you know, we're not overly prescriptive. We want to make sure that we're attuned to the needs of the state and the needs of their individual communities. And so we work with each individual state to make sure that, you know, they're working on policy that makes the most sense for them. And so in addition to the funding, we provide technical assistance and support kind of their grassroots activities and coalition building. And a little bit later, I'll go more into the resources that we provide. But also, a big priority of the program is to really facilitate connections between our grantees. So we want to make sure that, you know, we can kind of foster that networking and sharing of best practices. And even though every state is different, there's a lot of lessons that can be learned and, you know, examples of ways that states overcame challenges that can be beneficial for other states. So we do a lot of work to make sure that our grantees are connecting with one another and can learn from each other. And so to date, we have funded eight states, so Arkansas, California, Colorado, Kentucky, Louisiana, Nebraska, Rhode Island, and Texas. And we haven't officially announced it yet, but our new class of Catalyst grantees is coming on board here later this month. And so we will also be working with New York, New Jersey, Virginia, and Indiana. Next slide, please. And so part of the Catalyst program as well is, you know, we really wanted to leverage our partnerships with some of our national partners. So as you'll hear shortly from my friends and colleagues, James, the American Cancer Society Cancer Action Network does a great job of advocacy at the state and the federal level. They have chapters in all 50 states. We are not trying to recreate the wheel. But instead, we want to work with them and help support them and help to make sure that they're able to prioritize colorectal cancer. And so when we created the Catalyst program, we wanted to make sure that we were benefiting from kind of the knowledge and expertise from our partners. So we created a Catalyst Advisory Council with members from the CDC, the Prevent Cancer Foundation, and American Cancer Society Cancer Action Network. So they help us to select grantees and kind of go through that review process and also kind of to troubleshoot challenges along the way. So we're really grateful to those partners and to be able to, you know, lock arms with them around these important efforts. Next slide, please. So I mentioned before kind of some of the resources that we've developed through the Catalyst program, and I'll just kind of run through this quickly because I know this is a busy slide, but we have developed and worked with our grantees to develop one-pagers on their policy priorities that they can use when meeting with legislators. We've had webinars, like I kind of spoke about before, so that grantees can hear from other states and what worked and didn't work. We help with social media and also traditional media, developing press releases, and also have kind of regular check-ins with all of our grantees to sort of troubleshoot and if they need additional data or access to information or a subject matter expert, we work to make sure that we're connecting them with the information they need. We also use our advocacy platform to set up action alerts so our grantees can utilize that so that they can reach out to our database of folks in their state to get them to take action. And so all this is housed on our advocacy portal, which is of course, you know, open to the public, fightcrc.org, slash advocacy. We have a really robust resource library that we're adding to all the time. So as you can see at the top, you know, we have sample letters of support. We have testimony and other, you know, bill text. So we really want to make sure that everyone who is interested in doing this work has access to those resources. Next slide, please. So again, this is just kind of a quick overview of the advocacy portal and, you know, kind of what you can expect when you check that out. It has all of our state resources and federal as well. Next slide, please. And so then another key resource for our Catalyst grantees is action planning. So we provide them with a professional facilitator, and they are given eight hours of action planning work. When we first conceived of this program, it was pre-COVID. So we were envisioning, you know, kind of an all-day meeting. But just like everything else, we've had to, you know, rethink that. And it's actually worked out really beautifully. And so we kind of break up the action planning typically in two-hour chunks. And it's just a really great opportunity for advocates to, or excuse me, grantees to think through, first and foremost, you know, who are the key stakeholders in these efforts? Who needs to be in the room? Obviously, you know, patients, physicians, public health professionals, you know, other representatives from, you know, communities in their state. And so it's been a great way to really broaden the effort. And I think, you know, in many states, and James can speak to this later, it's been a great way to engage the physician community around this effort in particular. And so, you know, the action planning process is to really help grantees think through, you know, first and foremost, what's our goal? And do we all have buy-in in that goal? But then how are we getting to that goal? What are the milestones? What are the kind of tactical steps along the way that's going to get us there? And so I think it's really helped to keep people on track, especially in a virtual environment, and to really think through kind of all the different sort of resources and tools at their disposal. Next slide, please. And so then also just kind of briefly talk about our work with the Arkansas Center for Health Innovation. So, you know, data is obviously a critical component of any advocacy effort. And many legislators, you know, will come and, you know, ask kind of what the data is around this effort. And so we worked with ACAI. Arkansas was one of our grantees, and they actually successfully passed legislation last year, which was really exciting. And so they, Arkansas has an all-payer claims database. So they kind of layer the all-payer claims database with state registry and other data to be able to build these models around screening at 45, but also kind of the scope and impact of the follow-up issue. So this is just kind of a snapshot of what that, this sort of one-pager infographic that they created looks like. But what we're really excited about is, you know, obviously this is just for one state, and we wanted it to be, you know, accessible to everyone. So not only did they create this infographic for us, but they also created a really robust guide of where they got the data, how they got the data, how they framed it, and why. So it's kind of a step-by-step guide for other states to say, okay, we can get this data in our state, or this is where we need to go to find it. And it can kind of help guide them to create a similar document in their own state. Next slide, please. So our catalyst states. So I kind of already mentioned them earlier, so, you know, I won't go through it again. But each year, we bring on a new kind of cohort of catalyst states, and the grant term is typically for two years. So, you know, it kind of gives time for states to go through kind of that planning process and getting ready. And then, you know, kind of get to work in the second year. And so, you know, we've really tried to make sure that we have kind of, you know, regional diversity and are working in different types of states. But of course, if your state is not highlighted in one of these colors, you know, we are going to continue to expand. And we've also set aside some dollars this year for states who perhaps are not quite as far along in the process, who, you know, want to get involved in colorectal cancer policy, but maybe they don't quite have a coalition built, or they don't quite know what kind of policy they want to work on. You know, we have some dollars set aside to help those states kind of in those beginning phases think through, you know, how they can start to get engaged in this work. So, definitely, we'll be in more states soon. Next slide, please. And so, this is just kind of a really, really quick overview of what the various states are working on. So, Colorado, Nebraska, Indiana, New York, New Jersey, and Virginia, those last four being our brand new Catalyst grantees. So, they haven't even gotten fully started yet. But these states are working and have been working and are going to continue to work on legislation to not only remove out-of-pocket costs for that follow-up colonoscopy, but also making sure that they're codifying access to colorectal cancer screening beginning at age 45. And then, Louisiana is a bit of a unique case. And I think this kind of speaks to, again, you know, our hope that we can work with states to figure out what works best for them. But Louisiana came to us and, you know, said, look, we have a very conservative legislature. It's going to be difficult to get legislation like this through the legislature. But we have already set up a payers council that involves all the largest payers in the state of Louisiana. And so, they have been working through their payers council to get work with the insurers directly to update their policies around colorectal cancer screening. So, they've been going through kind of a process right now of figuring out exactly what each insurer's policy looks like, what it says kind of on the insurer level, but also, you know, what the patient journey looks like. And, you know, if there's any kind of discrepancies there. So, it's been really exciting to work with them and to think about the different layers, or excuse me, the different levers in terms of advocacy, and kind of different ways that we can move these issues forward. Next slide. And so, we've also had a number of really exciting victories. And, you know, in just a short time of having the program and having, you know, the first real year of the program be 2020. And, you know, when the world turned upside down, we weren't sure what things were going to look like, but we've had really incredible grantees and have been able to be successful in a number of different states. So, in Arkansas and Texas in particular, the governor signed into law legislation around the follow-up colonoscopy issue, as well as screening at 45. And so, James will kind of dig into that in a bit more detail on how they were able to secure those victories. But we also saw legislation signed into law in California and Rhode Island around the follow-up issue. And I think just the diversity of those four states speaks to the importance of this issue and ultimately the nonpartisan or bipartisan nature of this issue. And so, we're really excited to hopefully add to that list. And then Kentucky, you know, if any of you are familiar with Kentucky or from Kentucky, they have really been a leader in colorectal cancer screening policy. They obviously have a lot of challenges when it comes to screening, but they've been very active in their legislature in supporting access to screening. And so, they have been able to pass kind of additional legislation this past year, kind of codifying access to screening in Medicaid. But also, one of their kind of main projects was getting a protocol approved through their Board of Pharmacy to allow pharmacists to provide stool-based tests at the pharmacy counter. So, that was a really interesting process to work with them on. This is a first-in-the-nation kind of pilot program, and we worked with a number of different stakeholders, obviously pharmacists, health plans, physicians to kind of think through what that process will look like, what the patient journey would be. And so, that's been kind of officially approved by the Board of Pharmacy, and pharmacists will have to go through an education and training program to be able to provide those stool-based tests. But we're excited to see kind of the, you know, potential benefit that that can bring to folks in Kentucky. Next slide, please. So, really quickly, I know I've kind of probably gone over time, but we are also working on the follow-up colonoscopy at the federal level. So we have really focused our efforts on the agency side of things. So we're hoping to avoid having to introduce legislation, but instead work with CMS and the Department of Labor and others to get them to, you know, make this change on the regulatory side. So we've had some great conversations with the agencies. You know, there was language in the recent USPSTF guidelines that, you know, kind of talked about the necessary colonoscopy following these non-invasive tests. So we're, you know, hopeful that we'll be able to fix this on the federal level as well. Next slide, please. And I'll just kind of skip this for now. We can talk about this when we get into questions, but I'm very happy to turn it over to James. Molly, I appreciate that. And I just want to reinforce that Molly and FightCRC have been really critical partners in all the work we're doing, particularly for me in Arkansas and Texas, to pass these bills. And then just a quick shout out, I see a name, Dr. Allen, who I haven't met Dr. Allen before, but I know he's doing great work over in East Texas, particularly through UT Tyler with the CPERT grant. And so it's really just kind of great to see folks that are doing good work on this call. And then, of course, just thank you to ACPM for allowing us to tell our story. And what I'd like to do is just talk a little bit about, you know, who we are at ACSCAN, talk a little bit about how we approach our work, really talk about the importance of public health professionals being part of advocacy, and then highlighting some of the components of a successful campaign, particularly the campaign here in Texas, but some of the work we did in Arkansas. So my organization is 20 years old, we just turned 20 years. We are the sister advocacy organization for the American Cancer Society. We organized as a cancer action network 20 years ago as a 501c4. We do not endorse candidates, we do not give money to the candidates, cancer is nonpartisan, but being a 501c4 allows you to talk about issues and be more aggressive in how you do your advocacy work and has certainly served us well. The power of this organization is our infrastructure. We have volunteers throughout the country, well over a million volunteers. We have trained volunteers in every single congressional district in this country. And then, of course, we have state staff. So all 50 states have ACSCAN staff working in capitals to shape public policy, really to be the voice for cancer patients and drive public policy that would reduce the burden of cancer in our respective states and in society. So, you know, we're very proud of the work that we've done. The C3 side, the American Cancer Society continues to do the great work that it does, but I'm very excited about the commitment that my organization has made to advocacy and the return on investment they've gotten from that. So next slide, please. This will give you a general sense of the kind of broad range of issues that we work on, and we work on policy at all levels. So we work on policies at the local level. So a lot of communities that are smoke-free, like Tyler, for example, we have worked on and helped make those communities smoke-free. We work at the state level. So we're actively right now being the voice of the cancer patient in a place like Texas as they debate the vaccine and how we actually enforce the vaccine in the state of Texas. But we also work at the federal level, and we can't forget that the federal government is the largest funder of cancer research. And our volunteers and our, you know, the work we do really depends on that federal funding. And so it's a broad range of issues, and we attack cancer from a lot of different angles. And each state might take on a set of issues, but they all fit into these seven categories. But how we decide on what our legislative agenda is really what has political expediency, what can actually move in a respective state, that will have an impact on our mission. So next slide, please. So I share this photo with you because this is what we look like. This is the organization that I am so proud of and really has had such an impact in shaping public policy. And this photo is really important because if you knew these individuals, you'd see a lot of different constituencies. You'd see cancer patients, you would see healthcare professionals, you'd see physicians, researchers, that is our volunteer base. I cannot think of a single legislative issue that I have worked on in my 20 plus years for this organization or healthcare professional. Similar to those of you on this call today, haven't been critical to the success, the success of our advocacy efforts in getting that piece of legislation passed. Even more interesting is that for those of you that don't know, this is Senator Ted Cruz from Texas, his sister's a physician, right? So medical professionals certainly have the credibility, but more importantly, the access to kind of help us shape public policy. And then the next slide, I think is kind of interesting. And I put it up here for a couple of different reasons. One is because I think it really justifies why organizations like the American Cancer Society and the Cancer Action Network are engaged in public policy. And what it basically kind of shows you is the public is looking for a credible voice on public policy issues like cancer. And so when you ask voters who has that credible voice, it's organizations like the American Cancer Society, the American Cancer Society, Cancer Action Network, the Texas Medical Association. And what's even more interesting, and this I think speaks directly to this audience, I can show you other slides that will tell you that physicians and nurses are the most credible voice in helping elected officials, helping constituents, helping voters understand what's a credible public policy issue. And I jokingly say that if you're a physician who volunteers for the American Cancer Society, you're really untouchable. You have about a 95% credibility rating. And those are the individuals that we bring into our work because their ability to talk about a legislative issue, really from a practical standpoint and talk about an issue, how an issue affects a constituent, and more importantly, a district, is very compelling and very convincing for elected officials. So next slide, please. So I want to talk a little bit about the Texas experience and just highlight some of the key components. Campaigns like this just don't happen. There's a lot of strategy that goes into building a campaign. Molly and her team with Fight CRC were critical, not just in providing funding, but more importantly, kind of providing guidance and bringing us through a coalition building process. Coalitions are so important for a lot of different reasons. One is you need to get as many folks to the table as possible to make sure we agree on what the ask is, the legislative ask is. But more importantly, all politics is local. So the broader the coalition, the more you can localize an issue for an elected official, the greater impact you're going to have. And so taking us through kind of a long process, a very thorough process and a very effective process and kind of building the coalition, really talking about what deal breakers were, then more importantly, figuring out how the Texas coalition was going to work together was so important. That began about a year ago. So probably four or five months before the last legislative session in which we introduced a piece of legislation. This was a really exciting campaign for a lot of reasons. In the Texas Capitol, the discussion around cancer is a little bit unique because the state of Texas has made a significant commitment to fighting cancer through the Cancer Prevention and Research Institute of Texas. It's a $6 billion initiative. It's a state agency. So we get to talk about public policy, not only from the kind of cancer lens or the patient lens, but also through the lens of what Texas is already doing to fight cancer. But it was also a challenging session because you had COVID and it was really kind of hard to access people, particularly legislators. But we were able to do that. And it was hard to get people into the building, but our volunteers and our survivors were so passionate. They actually came into the building with us and testified and did meetings and so on. I tell a lot of stories and this particular issue, this particular legislative issue has a lot of stories that come with it. Cancer in general does because everybody in the Texas Capitol, for the most part, has a cancer story, whether a staff person or elected official. And that cancer story allows you to kind of connect with them and really talk about why this issue is so important, maybe to a loved one, but certainly to a district. So what made all the difference in this piece of legislation, and there are a lot of different places where this bill could have got derailed, but we were sitting with a staff person. We have a kind of a go-to Republican legislator who has been very good and carried a lot of our legislative issues successfully over the years, but meeting with this kind of legislative staff person. And in Texas, we have a large legislative staff for senate office. So you've got to get a senate staffer to really kind of own the issue and then kind of lead those, in some ways, kind of lead the senator, lead the senator's kind of efforts to kind of advocate for the issue with that senator's colleagues. And meeting with a staffer, it was really clear this issue was important and we asked why. And he's a 28-year-old staffer who had been diagnosed with colorectal cancer about a year and a half prior. So he understood the issue. And once he understood, particularly early onset colorectal cancer and why this bill was so important in addressing that, it became very personal to him. And at a really challenging session, you needed somebody that really could personalize this and add the kind of the kind of backroom momentum to get a bill like this passed. That meeting wouldn't have happened unless we had a medical professional and a survivor at the table and a survivor sharing their story about why this bill was important to them, allowing that staff person to feel safe to be able to share their story. And it's little things like that that is such an integral part of our strategy. Some of you that are from Texas remember the kind of winter shutdown. We had a pretty traumatic winter storm that shut down our state for about a week. It shut down our legislature for about a week. And more importantly, it actually changed the direction of the debate on issues that were priorities. So what was a priority prior to the winter storm was no longer a priority after the winter storm. So it was really critical for us to get back into the Capitol and talk about this issue still being important, personalizing this issue, more importantly, giving it momentum and making it a priority for the legislature. How we did that, we did that through survivors and healthcare professionals going back into the Capitol, reaching out to their elected officials and kind of reinforcing this issue is still important. It's actually more important now because of the pandemic. And then, of course, having the right legislative champions. There are a lot of legislators that don't really see a role around cancer control, but there are a lot that do. And once you identify them, and we've been lucky in the state to identify them, getting them to own the issue and making this a priority for them and their office is critical. We had the right legislative champions, Senator Huffman from Houston and then Senator Smithy from kind of Amarillo, kind of panhandle part of Texas, were our House and Senate champions. And, you know, this issue, I talked a lot about the challenges that we faced, but it also ran into the typical challenges. Health plans don't like mandates and health plans were facing a lot of mandates in the state of Texas this session and spending a lot of time beating mandates back. So, they put this into this bill, which was really just updating a lot from 2001 that the legislature passed. They put this into that mandate box. And so, we had to spend a lot of time working with the health plans to kind of back them away from the mandate discussion. And we did somewhat successfully, but at the end of the day, they still talked about this as a mandate. But it really meant that we had to kind of change the way we talked about the issue when we talked to legislators. And one of the stories I tell that made all the difference is the chairman, the House bill sponsor, used to chair the committee that the bill was heard before and chaired it 20 years ago when the original bill was heard. And the health plans came up and testified expressing concerns, talking about this bill as a mandate. And because of the institutional knowledge of this chairman, former chairman of this committee, he was able to talk about the bill 20 years ago when they voted on this bill in 2001 and really talk about the current bill doesn't meet current science. And that really addressed in a very clear cut and direct way the mandate issue and made this really a kind of a common sense piece of legislation. So that takes time. It takes time to build a campaign that allows you to find the champions to do that. More importantly, get the champions educated to be able to do things like that. And of course, the healthcare professionals have been critical in helping us kind of shape that. So next slide, please. So this is the headline. This is really what it's all about. We've been lucky in Texas to get this bill done in one session. Sometimes we look at bills like this and try to educate and then come back the next session, get it passed. This bill was signed by the governor and it was passed into, it was actually effective September 1 and now all health plans that are written as of January 1st, 2022 will include this coverage. And that is reducing the age to 45, but then more importantly, clarifying the follow-on screening for non-invasive positive tests. And again, there are so many places with this bill could have gone off the rails. And it was because of our volunteers and because of the work we get to do in the Capitol and because of patients and survivors and healthcare professionals being engaged on the front end of this campaign, that we avoided some of those pitfalls. And that's the quick overview of Texas. I know we're running low on time, but I just want to, I want to shift over to Arkansas just quickly and just show you the kind of the bill signing. Arkansas, I think it was in their second year of their campaign. This is Governor Hutchinson signing the bill. And this, again, this is such a great photo because what does it show? It shows healthcare professionals and survivors surrounding the governor. All of them were critical to the success of this bill. What made this bill so, what allowed us to get this bill done this session was a supportive fight CRC, certainly. But there's a house member, Representative Allen, who's a cancer survivor, colorectal cancer survivor. Well, he talks about his story publicly and he had just come back from treatment the weekend before the bill was heard. And we were kind of running into it. We were stalling a little bit in the house side, and he really talked a lot about why this bill was so important. And it was a long weekend. It was a three-day weekend. He says, I just want you to know, I was off in Atlanta getting treated for my colon cancer over the last three days. And I want you to know I came back to be able to talk about this bill because we can save more lives with this piece of legislation than my physician might be able to save in his entire, his or her entire career. That kind of testimonial, that kind of passion, that kind of legislative champion can make all the difference. And we have those in each of our states because the work that we're doing. So again, just really great success. The partnership we have with FightCRC is invaluable. And I'm going to stop there and take some questions. How's that sound? Well, thank you both for those wonderful presentations. And participants, please type your message into the chat and I'll read them aloud. But I have a few questions to kick us off. What have been the biggest challenges to advancing colorectal cancer screening policy at the state level? Both Molly and James. Molly, if you could come back on. Yeah, I'm happy to start, although I think James has been on the ground and can certainly give you a better sense. But I think one thing that James talked about was that this is generally something that the insurance industry is not excited about. And it's not even necessarily the policy itself, but it's this idea of a mandate and any kind of legislative effort to confine or constrain or force them to do something. So in many of our states, that's definitely been a challenge that we've had to contend with. I think another piece that James also mentioned was a lot of this work has been done amongst the backdrop of COVID-19. So there are a lot of different issues that state legislatures are dealing with and are grappling with. And so to kind of get the attention of legislators, get the time on the calendar, kind of get the time on the floor can be a challenge as well. Yeah, I would reinforce both of those. It's really critical. We had negotiated with the health plans in both states. We were able to negotiate some consensus in Arkansas. Still, I don't think they were completely comfortable with the bill, but they ended up kind of pulling back and being neutral, which was good. And it's an interesting discussion because you're meeting with medical directors when you're having some of these... In some states, you're meeting with medical directors of the plans and they're bringing up some valid concerns. But at the end of the day, I think our data certainly reinforces why this bill is so important. I'd also say, particularly the mandate issue, and this is more constituent work. There are 7,000 bills in Texas every single session, and many of them are mandates. And it's really about distinguishing why this isn't a mandate. And it's always about personalizing the bill. So it's finding members that can really share their story. And we've done that. And we actually bank stories of legislators that are survivors that have been touched by cancer. We actually do a publication where they actually tell their story. So we humanize it. And so we really go away from talking about mandates and just making them, particularly with constituents, really putting a face and a voice to the issue. So they don't... You kind of take that mandate argument away. Thank you. What are some reasons for the increase in colorectal cancer among 45 to 49-year-olds in this country? So we don't have a full picture of that. And I think that's part of the challenge. We don't have a definitive answer. And that's really why additional funding for research is so important and is such a big priority for both Fight CRC and ACS CAN. Obviously, the traditional risk factors are obviously at play in the younger populations as well. But we're seeing a lot of folks that are even younger than 45. We work with a lot of people that are in their 20s and 30s who are being diagnosed with late-stage disease. And so a handful of them or a certain cohort of them have family history, but many have more sporadic disease. So unfortunately, we don't really have a great answer for that. But hopefully soon we will. Same for us. We're studying it. We think it might be a link to lack of physical activity, obesity, things like that. But we're still looking at the data now. Thank you. Here's another. How has the COVID-19 pandemic impacted screening for colorectal cancer? Are there data yet available on reductions in screening procedures and perhaps subsequently down the road increasing colorectal cancer rates? Yeah. So Fight CRC, we have a partnership with Komodo Health, which has access to claims data from across the country for both private and public payers. And I would say the summer of 2020 came out with data showing that in the months just following the beginning, I guess you could say, of the pandemic, colorectal cancer screening decreased by as much as 90%. And we've seen much of that come back. But as I mentioned before, we're now kind of seeing in certain parts of the country, this closing again of healthcare facilities to elective procedures. And so I don't know. While there's been a lot of data out there as to the impact, I don't know that we will obviously fully see the full picture until many years down the line. But there's been data from the NCI estimating as many as over 4,000 additional colorectal cancer diagnoses because of the downturn in screening due to the pandemic. And I think in that research, they said that that was a conservative estimate. So it's definitely something that we're very concerned about. And I think I've seen some articles recently that physicians are already starting to see these kind of later stage cases of folks who've kind of put off seeking medical care because of a variety of issues, but certainly related to the pandemic. Thank you. Another question. You all mentioned that advocacy starts at the local level most of the time. What does that mean exactly? And particularly, how is this relevant to more rural areas of the country? I can take that, Molly, if you want. For my organization, it looks like a couple of different... I guess it's in a couple of different efforts. So basically, we've invested a lot of time in Texas to try to make our state smoke-free and not having any luck at the state level, not getting a statewide bill passed. We've really worked at the local level. So we actually go in, and Dr. Allen, we've worked in Tyler before. We actually go in and much like this colorectal campaign, we build similar campaigns. We build a coalition. We actually kind of start educating the city council and try to pass a local smoke-free ordinance. And then we've leveraged that coalition to work with their state house member and state senator to try to build momentum at the state level for a statewide law. And so we've had great success. I think it's 70% of the state of Texas now is covered with smoke-free laws because we've been able to pass so many successfully. But more importantly, kind of all politics is local. I'm a lobbyist. My job is to go in and talk to elected officials about why this issue is important. And because I work for the American Cancer Society, Cancer Action Network, I bring credibility, but they always want to know what it means back in the district. So tell me what this means back in my hometown. Because of the reach of my organization, I can bring a volunteer, a constituent, sometimes a survivor from their hometown that would talk about the issue in really personal ways. So we have trained volunteers in Tyler that travel to D.C. with us. They come to Austin and advocate for us. They get on the call with your state representative, your state senator and advocate for these issues. So it is that local presence that makes all the difference, that local constituent that makes all the difference, and our ability to advocate. And that's the strength of my organization, being able to put a constituent in front of almost any single lawmaker, a legislator, to convince, to personalize the issue and really localize it and why it's so important to their community. Thanks. Sorry, I would just add to that quickly. I think that actually COVID-19 and sort of the shift to virtual has only helped that kind of process and allowed for individuals who maybe can't travel to D.C., can't travel to their state capital or who never kind of really saw that as an option to get engaged in advocacy and to get engaged in this work. And, you know, there's, to James's point, there's a lot of different ways that you can do that and kind of offer your story and a lot of different mediums for that. But there's just, you know, kind of no substitute for that personal story and for legislators hearing from the folks that ultimately vote for them. And the preventive medicine physicians and all physicians have an important voice at that table. Okay, we are almost at time. We have one more slide to share. We want to thank you for attending today. And I wanted to alert you to an upcoming ACPM webinar addressing health misinformation through health literacy on October 28th at 3 o'clock. Please be on the lookout for the event survey and for more information on our, all of our programs that are housed in our learning management system, just log on to the link that you see below, acpm.org slash education dash events. So thank you both so much for excellent presentations. And we look forward to continuing the conversation and working closely with both of you in the future. Thank you. Thank you, Angela. Thank you.

webinar

advocacy

colorectal cancer screening

funding

state statutes

legislation

healthcare professionals

research

younger populations