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Enhancing Chlamydia Screening in Managed Care; Collaboration in California Romni Neiman Chief, Office of Program Development STD Control Branch California Department of Health Services
Enhancing Chlamydia Screening in Managed
Care;Collaboration in California
Romni NeimanChief, Office of Program Development
STD Control BranchCalifornia Department of Health Services
Why Partner for Prevention? Most common communicable disease
reported in CA Over 100,000 reported cases in 2001 Over 75% of cases are seen in the private sector
Significant Health Consequences Most common cause of preventable infertility Facilitates sexual transmission of HIV
Asymptomatic nature of STD infection demands intervention in the primary care setting
HEDIS increases private sector interest Potential public/private partnership
5.6
8.8
15.5
9.4
22.3
3.3
6.2 6.5
13.4
0
5
10
15
20
25
Managed CareOrganization
FamilyPlanningClinics
Juvenile Hall CommunityOutreach
STD Clinics
15–19 20–24
Prevalence of Chlamydia Infections for Females Age 15–19 and 20–24 by Health
Care Setting, California, 2000
Percent Positive
Source: California Department of Health Services, STD Control Branch; Los Angeles Infertility Prevention Project; and San Francisco Infertility Prevention Project
Proportion of EligibleWomen Screened(Median)
Family PACT ~65%
MMC ~27%
Kaiser ~40%
Pilot of HEDIS Chlamydia Screening Measure in California
Engaging Stakeholders - First Steps Policy Development
Negotiation of STD Purchasing Specifications with Medi-Cal Managed Care (California’s Medicaid)
Surveillance and Data Analysis Assessment of Screening Practices with Kaiser
Permanente Northern California (KPNC)
Health Education OPTIONS Comprehensive newsletter to KPNC teens HealthNet’s Strategic Plan for the Prevention and
Control of STDs
Engaging Stakeholders First Steps
California Chlamydia Action Coalition (CCAC)Strategic Planning Meeting (October 1998)
Develop Goals, Recommendations and Action Steps
Release of Chlamydia Action Plan (March 2000)California HealthCare Foundation Grant Award
(January 2000) Committee Structure
Executive Steering Committee, Scientific Advisory Committee, Policy Committee, Awareness Committee
Strategic Planning Meeting (November 2001) Revise Action Steps and Plan
Health Plan ConcernsChlamydia Screening
Measure Ability to accurately capture
screening dataACTION:Development of Centralized Data Warehouse
with Electronic Transmission of Chlamydia Screening Data
Inconsistencies in chlamydia screening recommendationsACTION:Development of Chlamydia Practice
Guidelines
California’s Chlamydia Quality Improvement Initiatives
Chlamydia Screening and Treatment Practice Guidelines & Chlamydia Care Quality Improvement Toolkit
Medi-Cal (California’s Medicaid) Managed Care Quality Improvement Initiative
Chlamydia Screening & Treatment Practice Guidelines (CPG)
May 2001: Stakeholder meeting Review Chlamydia Clinical Practice Guideline
Discuss statewide quality initiative and toolbox
Instrumental in bringing state-wide consensus to the issue of chlamydia screening and treatment
Available on CCAC websitehttp://www.ucsf.edu/castd
Chlamydia Care Quality Improvement Toolbox A collection of resources that can be
utilized by health plans, medical groups and provider organizations to:Educate physicians, providers,
members and patients about chlamydia screening, diagnosis and treatment
Promote compliance with guidelines
Toolbox Contents
Clinical Practice Guideline (CPG)
Diagnosis and Treatment of Chlamydia in Pregnancy
Screening Tests for Chlamydia
Sexual History Taking CA Public Health Laws
and Regulations Related to Chlamydia
Centers for Disease Control and Prevention STD Guidelines
Chlamydia Quality Improvement Activities and NCQA
Provider Education Patient Education Chlamydia
Presentation
Medi-Cal Managed Care Chlamydia Quality Initiative
Medi-Cal Managed Care DivisionAdministered by CA DHS Largest insurer in the state
approximately 2.5 million enrollees, expanding to 3 million
60% of managed care population in MMCDContracts with 36 plans in 23 countiesMandated Subcontracts for Public Health
Services
Medi-Cal Managed Care Chlamydia Quality Initiative
Components HEDIS Measurement Adoption of the Chlamydia Clinical
Practice Guidelines Web-based Provider Training Module Individualized Health Plan/Provider
Incentives
Medi-Cal Managed Care Chlamydia Quality Initiative
Evaluation HEDIS Measurement & Re-measurement Provider level data regarding screening
practices and plan incentives Web-based module report generation Provider Practice Survey
Medi-Cal Managed Care Chlamydia Quality Initiative
Process Collaborative project between MMCD,
STD Control Branch, CA HIV/STD Prevention Training Center and MMCD Quality Improvement Subcommittee on Chlamydia (Health Plan representation)
Joint development of project protocols, provider education materials, surveys, etc.
Facilitators
Our Charge“The department shall develop and review
plans and provide leadership and consultation for and participate in, a program for the prevention and control of venereal disease.”
HEDIS Chlamydia Screening MeasurePotential public/private partnership
Chlamydia Cost-effectiveness Research
Facilitators Dedicated staff with diverse skills and abilities
MDs with professional expertise and respect of colleagues
Epidemiology staff to provide data management & analysis
Clinical expertise and design savvy to develop medically sound, user friendly educational materials
Health education staff to develop prevention materials
Program liaisons to facilitate communication, partnership and project development
Lessons Learned
Managed Care can be successfully involved in STD prevention and care
Keys to success are:Strategic planning to create a common vision
and to develop goals that are beneficial to all
Multifaceted approaches that include providers, insurers, researchers, patients, and policymakers
Incentives like HEDIS & Quality Initiatives
