Effort to Initiate a Chlamydia Prevalence Study within a Managed Care Organization in Philadelphia

1. Effort to Initiate a Chlamydia Prevalence Study within a Managed Care Organization in Philadelphia Pamela G. Nathanson, Dorothy Mann Family Planning Council, Inc. Philadelphia, PA

2. Background • Region III Chlamydia Project Advisory Committee expressed interest in determining chlamydia positivity in private sector. • Little data existed on prevalence in commercial managed care organizations. • Family Planning Council and CDC partnered to initiate a prevalence study in a managed care organization in Philadelphia.

3. Objectives • Describe the process of working with a large MCO to develop a prevalence study. • Describe successes and challenges encountered in working with the MCO to implement the study. • Explore potential next steps.

4. The Players • Family Planning Council – Administrative body for the Region III Chlamydia Project. • Centers for Disease Control and Prevention – Division of STD Prevention, Health Services Research and Evaluation Branch. • Independence Blue Cross – largest network plan in Southeastern Pennsylvania.

5. The Process • Initial contact was made with OB/Gyn Medical Director at IBC who had already expressed interest in improving their STD services. • Meetings/conference calls held with OB/Gyn and overall Medical Directors to discuss development of study. • Initial protocol drafted by CDC. • Potential funding sources identified.

6. Purpose of the Study • Determine the prevalence of chlamydia among commercially insured women ages 20-25 receiving care in private ob/gyn offices. • Use the results to increase the rate of chlamydia screening by improving provider compliance with existing screening protocols.

7. The Proposed Study • Provide cervical NAAT chlamydia screening to all women ages 20-25 undergoing pelvic exams in selected IBC Ob/gyn offices. • Collect data on DOB, race/ethnicity, zip code, provider code, test result. • Determine prevalence by provider. • Study to run for six months.

8. Successes • Initiated contact – got the issue somewhere on the radar screen. • Generated interest in supporting the study – CDC, Pfizer, Roche Diagnostics • Learned more about IBC administrative and logistical operations, especially data and laboratory organization.

9. Stumbling Blocks • Lack of understanding of the disease • Medical Director was unfamiliar with the asymptomatic nature of CT, high prevalence rates, and sequelae. • Lack of concern about downstream costs • In spite of prior cost-effectiveness data, IBC not concerned about paying for treatment of PID and other sequelae in the future. • Little consequence of HEDIS measure • Sense that purchasers are not concerned about chlamydia screening.

10. Stumbling Blocks • No connection acknowledged between knowing prevalence and changing physician behavior. • Contract laboratory not interested in collaborating in the study – very interested in charging high prices for testing. • Concern about liability • Medical Director feared that patients would be resistant to screening, and that this liability would not be outweighed by the benefits

11. Conclusions • Chlamydia screening is not important to the plan – still not on the radar screen. • HEDIS measure is not enough of a motivator – plan sees no consequences of a score of less than 20% on the HEDIS measure. • Chlamydia is a “small ticket” item for the plan – little motivation to make a change.

12. Next Steps • Region III exploring barriers to screening among commercial MCOs in the region. • Planning to conduct a chlamydia prevalence study among private physician groups rather than working through health plans. • Hope to use data gathered to help plans increase screening efforts and improve performance on HEDIS measure.