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Infertility Prevention Project Region I Advisory Board Meeting Lessons Learned In Michigan. Amy Peterson, MPH Michigan Department of Community Health June 1, 2009. Presentation Topics. Michigan Background Quick and Dirty Cost Savings Analysis Use of Cost Saving Information

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infertility prevention project region i advisory board meeting lessons learned in michigan

Infertility Prevention Project Region I Advisory Board MeetingLessons Learned In Michigan

Amy Peterson, MPHMichigan Department of Community HealthJune 1, 2009

presentation topics
Presentation Topics
  • Michigan Background
  • Quick and Dirty Cost Savings Analysis
  • Use of Cost Saving Information
  • Michigan IPP Program Management
  • Targeted Expansion
  • Gonorrhea/Chlamydia Reduction Plan
  • Program Expansion and Contraction
gonorrhea and chlamydia burden in michigan
Gonorrhea and Chlamydia Burden in Michigan

46,555 reported cases of chlamydia

77% age ≤ 24

17,905 reported cases of gonorrhea

66% age ≤ 24

* All numbers reflect CY 2008


michigan ipp tie dye
Michigan IPP Tie-Dye
  • Quarterly Alliance Meetings
    • STD
    • FP
    • Bureau of Labs
    • Adolescent Health
    • Oakland County
    • Juvenile Detention
ipp screening activity
IPP Screening Activity

Calendar Year 2008

~ 105,000 (104,621) screened for chlamydia

Over 10.3% (10,789) found positive

75% of positives are 15-24 yrs/age (63% of tests)

~ 90,000 (91,835) screened for gonorrhea

4.2% (3,840) found positive

61% of all positives are 15-24 yrs/age (58% of tests)

Diagnose ~23% of the State’s morbidity


funding for ipp activity
Funding for IPP Activity
  • STD
    • Federal IPP (tests/administration)
    • State General Fund/Michigan Health Initiative (tests/administration)
    • Local Public Health Operating funds (staff)
    • Local health jurisdiction funding (staff)
  • Family Planning
    • Tests and Plan First!/Medicaid
  • Adolescent and School Health Program
    • Tests/coordinating consultant
cost savings analysis
Cost Savings Analysis
  • Began as a way to avoid cuts during 2007 budget crisis
  • Good PR tool for all stakeholders
    • Local Health Jurisdiction – IPP analysis
    • Medicaid cost analysis
steps in michigan s unscientific formula
Steps in Michigan’s Unscientific Formula
  • Identify number of FEMALES diagnosed with CT and/or GC in population of choice (IPP, total morbidity, persons on Medicaid, etc)
  • Apply CDC statement – undiagnosed 30-40% may progress to PID
  • Multiply # positives times .40, times cost of treating a case of PID (multiple reference articles available).
  • Add disclaimers and footnotes
  • Use terms like “estimated” and “expected” frequently
medicaid cost savings analysis
Medicaid Cost Savings Analysis
  • Two calculations:
    • Estimated amount saved based on avoided PID at current screening level
    • Cost to treat cases of PID which could have been avoided with 100% screening of eligible patients
medicaid analysis data sources
Medicaid Analysis Data Sources
  • Requested data from Michigan Medical Services Administration, Data Analysis and Quality Assurance Section (MSA)
  • Number screened was gathered from the Medicare Managed Care Annual Report
  • Received number diagnosed with PID by race from MSA – based on diagnosis code
  • MSA system does not collect number of positives, only number of tests. Received aggregate count by age and race; # of positives were estimated based on Michigan case rates.
  • See handout for details
missed screening opportunities cost michigan money
Missed Screening Opportunities Cost Michigan Money
  • Amount spent by Medicaid to screen female members age 16-25 in 2006 –
    • ~ $2.2 million
  • Cost to screen and treat 100% of eligible Medicaid female members age 16-25 in 2006 -
    • ~ $4 million
  • Cost to treat chlamydia related PID in 2006 –
    • ~ $5.5 million
cost savings analysis as advocacy tool
Cost Savings Analysis as Advocacy Tool
  • Garnering good will with screening partners and their upper level administrators
  • Build case for additional funding from State; proven cost savings for Medicaid
  • Advocate to keep resources based on “Evidence Based”, “Cost-Effective Public Health Strategy”
  • $ adds power to sound bites
program management
Program Management
  • Pre-Paid Forms
  • CT-only Testing Algorithm
  • Constant Monitoring of Usage
pre paid forms
Pre-Paid Forms
  • See handout
constant monitoring of utilization
Constant Monitoring of Utilization
  • Monitored semi-annually
  • Robin Hood approach to test re-allocation
juvenile detention adolescent health expansion
Juvenile Detention/Adolescent Health Expansion
  • 2002 – RVIPP Mini-grant to target juvenile detention
    • Children’s Village/ Lynda Byer
    • JD sites in high morbidity counties approached
    • School based health centers – Oakland
    • Statewide expansion with Carrie Tarry
wayne county juvenile detention
Wayne County Juvenile Detention
  • Over two years of trying, asking, begging
  • Multiple staff and attempts
  • New Medical Director – Dr. Carla Scott
  • Full implementation July 2006
  • 01/08 – 12/08 (paid for ½ of tests themselves)
    • 3,771 tested 770 F; 3001 M
    • 424 + CT (22% F, 9% M)
    • 87 + GC (6% F, 1.3% M)
dream big
Dream Big…
  • Focus on mission of program
  • Acknowledge uncomfortable decisions that come with limited resources
  • Challenge politics as usual
  • Target non-traditional partners
  • Target services to address health disparities (not just racial)
  • Look for yield from every test supported

Status Quo:

gonorrhea and chlamydia in


144 new infections per day

52,673* cases

per year

removing 144 infections per day

* Average 2002-2007

goal of initiative
Goal of Initiative

To decrease overall prevalence of gonorrhea and chlamydia by identifying and treating infected individuals at a faster rate than new infections occur.


evidence based components of the plan
Evidence Based Components of the Plan
  • Increase school-based screening
  • Implement universal screening of males in STD sites
  • Increase private sector screening
  • Support alternative site high-risk screening
evidence based components of the plan1
Evidence Based Components of the Plan
  • Implement CDC re-testing guideline
  • Utilize electronic medium to notify partners
  • Encourage field-delivered therapy for identified cases
  • Improve partner management in public and private sector
targeted expansion 2009 pilot projects in high morbidity areas
Targeted Expansion – 2009 Pilot Projects in High Morbidity Areas
  • School Blitz (8.3/11.9)
  • Teen Health Centers (19 CT, 5.2 GC)
  • Wayne County Jail (10 CT, 3 GC)
  • Pregnancy Test Only (10.2 vs. 7.5)
  • University Dorms (15 CT, 3.3 GC)
  • Federally Qualified Health Center – STD Overflow (11 CT, 4 GC)
  • Expanded Screening Initiative (ESI) Grants
  • Retesting
  • Universal male screening in STD Clinics
likely targeted contraction 2010
Likely Targeted Contraction - 2010
  • Maintaining screening criteria age limit at 24 years old
  • State support of health center screening at Oakland University – likely discontinued (6 / 9 CT)
  • ESI Grants – support for testing only
  • Discontinue universal male screening in STD clinics
targeted contraction 2010
Targeted Contraction - 2010
  • Reviewing Adolescent Health and Family Planning sites
    • cutting low prevalence sites to minimum
    • encouraging billing Medicaid and “Plan First!” when possible (50% estimated)
    • drill down analysis to ID who is testing positive and providing guidance
  • Shifting resources to high prevalence sites
calling on our partners in 2010
Calling on Our Partners in 2010
  • Adolescent health picking-up larger portion of costs
  • Targeted expansion to two new screening sites in high prevalence sites
  • Family Planning willing to make hard calls with low positivity sites
  • Increase attention to private sector (Nancy). Using LPH partners to increase knowledge and action among local providers
no low cost program improvements
No/ low cost program improvements
  • School blitz guidance
  • Messages to private sector through managed care organizations to increase attention to HEDIS measure
  • Re-test in current sites
  • Field delivered therapy guidance
  • Work with IPP providers to increase partner management capacity and intentions
questions contact

Amy Peterson

IPP Coordinator

Michigan Department of Community Health

STD Program