Transcript Male GC Cases

Enhancing Chlamydia Screening
in Managed Care;
Collaboration in California
Romni Neiman
Chief, Office of Program Development
STD Control Branch
California 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
Prevalence of Chlamydia Infections
for Females Age 15–19 and 20–24 by Health Care
Setting, California, 2000
25
22.3
20
Percent Positive
15.5
15
13.4
10
6.5
6.2
5.6
5
9.4
8.8
3.3
0
Managed Care
Organization
Family
Planning
Clinics
Juvenile Hall
15–19
Source:
Community
Outreach
STD Clinics
20–24
California Department of Health Services, STD Control Branch; Los Angeles Infertility Prevention Project; and San Francisco Infertility Prevention Project
Pilot of HEDIS Chlamydia Screening
Measure in California
Proportion of Eligible
Women Screened
(Median)
Family PACT
~65%
MMC
~27%
Kaiser
~40%
Engaging Stakeholders First Steps
Policy Development
 Negotiation of STD Purchasing Specifications with MediCal 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 Concerns
Chlamydia Screening Measure
Ability to accurately capture
screening data
ACTION:
Development of Centralized Data Warehouse
with Electronic Transmission of Chlamydia
Screening Data
Inconsistencies in chlamydia
screening recommendations
ACTION:
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 website
http://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 Division
Administered by CA DHS
Largest insurer in the state

approximately 2.5 million enrollees, expanding to 3
million
60% of managed care population in MMCD
Contracts with 36 plans in 23 counties
Mandated 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 Measure
Potential 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
For questions, please contact…
Romni Neiman
(510) 883-6655
[email protected]