Enhancing Chlamydia Screening in Managed Care; Collaboration in California

1. Enhancing Chlamydia Screening in Managed Care;Collaboration in California Romni Neiman Chief, Office of Program Development STD Control Branch California Department of Health Services

2. 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 demandsintervention in the primary care setting • HEDIS increases private sector interest • Potential public/private partnership

3. 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

4. Pilot of HEDIS Chlamydia Screening Measure in California

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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 Toolbox Contents

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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

18. 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

19. For questions, please contact… Romni Neiman (510) 883-6655 rneiman@dhs.ca..gov