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Collaboration and Chlamydia

Collaboration and Chlamydia. Susan DeLisle, ARNP, MPH National Chlamydia Coalition Provider Education Committee. National Chlamydia Coalition (NCC). Formed in 2008 Comprised of over 40 organizations Health care professional organizations Insurers Non-profit organizations

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Collaboration and Chlamydia

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  1. Collaboration and Chlamydia Susan DeLisle, ARNP, MPH National Chlamydia Coalition Provider Education Committee

  2. National Chlamydia Coalition (NCC) • Formed in 2008 • Comprised of over 40 organizations • Health care professional organizations • Insurers • Non-profit organizations • Local, state, federal government representatives • Managed by Partnership for Prevention • Funded by the Centers for Disease Control and Prevention • Mission • Address the high burden of chlamydia in adolescents and young adults by promoting equal access to comprehensive and quality health services

  3. Why a Collaboration with the NCQA? • NCQA recognizes hundreds of plans covering >136 million people (43% of the U.S. population) • NCQA is the most widely-recognized accreditation program in the United States • The NCQA seal is a recognized symbol of quality • NCQA is the developer of the Health Effectiveness Data Information Set (HEDIS) measures • The HEDIS chlamydia screening measure for women is part of the NCQA accreditation program

  4. National Committee on Quality Assurance (NCQA) • Accredited health plans meet a rigorous set of more than 60 standards and must report on performance in more than 40 areas to earn NCQA’s seal • NCQA develops quality standards and performance measures for a broad range of health care entities (not just health plans) • Health and Human Services (HHS) selected NCQA as an accrediting entity for Qualified Health Plan issuers participating in the Health Insurance Exchange Marketplace • Health plans in every state, the District of Columbia and Puerto Rico are NCQA Accredited

  5. Chlamydia Screening Measure: Why Focus on Health Plans? • In 2012, 3,863,618 sexually active women were seen in 626 health plans reporting on chlamydia HEDIS measure • Only 5 states have fewer than 5 health plans (AL, AK, AR, ND, WY) where data are not publically reported • However, plans in those states still report HEDIS data to NCQA • In 2012 less than half of eligible women were screened for chlamydia (49.2%)

  6. HEDIS Chlamydia Screening Measure • The percentage of women 15–24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. • Commercial, Medicaid (report each product line separately) • Ages: Women 16–24 years as of December 31 of the measurement year. Report two age stratifications and a total rate. • 16–20 years, 21–24 years, and Total • Allowable gap: No more than one gap in enrollment of up to 45 days during the measurement year. • Anchor date: December 31 of the measurement year.

  7. Sexually Active • Two methods identify sexually active women: pharmacy data and claim/encounter data. The organization must use both methods to identify the eligible population; however, a member only needs to be identified in one method to be eligible for the measure. • Pharmacy data. Members who were dispensed prescription contraceptives during the measurement year.

  8. Prescriptions to Identify Contraceptives Description • desogestrel-ethinylestradiol, drospirenone-ethinyl, • lestradiol,estradiol-medroxyprogesterone • ethinyl estradiol-ethynodiol,ethinyl • estradiol-etonogestrel,ethinyl estradiol-norethindrone • ethinyl estradiol, norgestimate, ethinyl estradio,l-norgestrel, etonogestrel • Levonorgestre, ethinyl estradiol-levonorgestrel,ethinyl estradiol-norelgestromin • Medroxyprogesterone,mestranol-norethindrone • Diaphragm • diaphragm • Spermicide • nonxynol 9

  9. Codes to Identify Sexually Active Women Description Codes • CPT 11975-11977, 57022, 57170, 58300, 58301, 58600, 58605, 58611, 58615, 58970, 58974, 58976, 59000, 59001, 59012, 59015, 59020, 59025, 59030, 59050, 59051, 59070, 59072, 59074, 59076, 59100, 59120, 59121, 59130, 59135, 59136, 59140, 59150, 59151, 59160, 59200, 59300, 59320, 59325, 59350, 59400, 59409, 59410, 59412, 59414, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622, 59812, 59820, 59821, 59830, 59840, 59841, 59850-59852, 59855-59857, 59866, 59870, 59871, 59897, 59898, 59899, 76801, 76805, 76811, 76813, 76815-76821, 76825-76828, 76941, 76945-76946, 80055, 81025, 82105, 82106, 82143, 82731, 83632, 83661-83664, 84163, 84702-84704, 86592-86593, 86631-86632, 87110, 87164, 87166, 87270, 87320, 87490-87492, 87590-87592, 87620-87622, 87660, 87800, 87801, 87808, 87810, 87850, 88141-88143, 88147, 88148, 88150, 88152-88155, 88164-88167, 88174-88175, 88235, 88267, 88269 • HCPCS G0101, G0123, G0124, G0141, G0143-G0145, G0147, G0148, H1000, H1001, H1003-H1005, P3000, P3001, Q0091, S0180, S0199, S4981, S8055 • ICD-9-CM Diagnosis 042, 054.10, 054.11, 054.12, 054.19, 078.11, 078.88, 079.4, 079.51-079.53, 079.88, 079.98, 091-097, 098.0, 098.10, 098.11, 098.15-098.19, 098.2, 098.30, 098.31, 098.35-098.8, 099, 131, 614-616, 622.3, 623.4, 626.7, 628, 630-679, 795.0, 795.1, 996.32, V01.6, V02.7, V02.8, V08, V15.7, V22-V28, V45.5, V61.5-V61.7, V69.2, V72.3, V72.4, V73.81, V73.88, V73.98, V74.5, V76.2 • ICD-9-CM Procedure 69.01, 69.02, 69.51, 69.52, 69.7, 72-75, 88.78, 97.24, 97.71, 97.73 • UB Revenue 0112, 0122, 0132, 0142, 0152, 0720-0722, 0724, 0729, 0923, 0925

  10. How Compliant are Providers with Annual Chlamydia Screening? 2012 Chlamydia Screening HEDIS Rates Health Plan Type Age (yrs) Commercial HMO (%) Medicaid HMO (%) _____ ________________ ____________ The State of Health Care Quality, 2011 National Center for Quality Assurance at: http://www.ncqa.org/LinkClick.aspx?fileticket=J8kEuhuPqxk%3d&tabid=836

  11. HEDIS Chlamydia Screening Rates

  12. HEDIS Chlamydia Screening Rates

  13. First Foray: Approaching the NCQA • Chlamydia screening recognition program? • Deemed too narrow • Might consider “sexual health” umbrella • HPV vaccine pre sexual activity • Pap smear screening (at 90%) • Treatment measure? • NCQA reviewed data and determined that once chlamydia was identified, treatment rate was 95% • Re-screening measure? • Confidentiality of reporting positive CT test • Problems with time interval post treatment using administrative data • Take Away Message: Primary problem is obtaining the initial screening test

  14. Second Foray: Presenting at HEDIS Best Practices Conferences • Annual meeting held on each coast • 200-300 quality improvement professionals from health plans and vendors attend • What’s new in HEDIS and other quality standards reviewed • Chlamydia screening featured topic in 2012 • Case study of improving chlamydia screening presented • Take Away: Reaching quality improvement professionals in health plans may be as (perhaps more?) important than reaching providers to improve chlamydia screening rates

  15. Current Collaboration: NCC and NCQA • NCQA staff on NCC provider education committee’s working group • Developing a 3 part webinar series designed to improve chlamydia screening HEDIS scores • One session per week from February 16 – week of March 2 • 90 minutes sessions • At least one case study per session

  16. Topics • Session I – Current News, on Chlamydia, Screening Measure, Specifications, and Performance • Overview of epidemiology, scope of problem, screening recommendations, treatment • HEDIS specifications (inclusions/exclusions), HEDIS rates over time, other programs where CT measure may meet quality improvement requirements • Case study in establishing a QI program • Session II – The path to Improving chlamydia screening HEDIS rates • Considerations and Addressing Barriers at the Plan level • Considerations and Addressing Barriers in the Practice setting • Two case studies from health plans and organizations that have improved

  17. Topics (cont’d) • Session III – Tools and Tips for Addressing Specific Barriers • National look at State laws on confidentiality • Confidentiality and sensitive services • Billing and EOB’s • Becoming adolescent friendly – taking a sexual history, talking with parents, time alone with teen, tools for providers and clinics • Education Materials – for patients, parents, providers and other staff • Case study from a plan with increased chlamydia screening among adolescents

  18. What Else To Do?“There’s something for everyone” • CDC could explore options for sharing plan specific data with states to reduce costs for grantees • Identify quality improvement, measurement, and evaluation departments within your health department • Find out whether HEDIS data are published in your state (many states do have this at insurance sites) • Health plans are very competitive • Explore health plan websites looking for NCQA accreditation or certification recognition • Find the names of quality assurance or quality improvement staff (these are often on plan websites)

  19. What Else To Do?“There’s something for everyone” • Promote the NCC/NCQA webinar series to health plans in your jurisdiction • We will distribute Save the Date and other marketing information • Let us know who, in your state, should be identified as a resource for health plans • Perhaps offer incentives to participate • Learn the language of the quality improvement world • Listen to the next speaker for a plethora of other ideas and potential motivators in approaching plans

  20. CAN

  21. Thank You

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