Region I Sneak Preview Future of IPP Regional Assessment Findings Future of IPP Assessment Region I Sneak Preview Future of IPP Regional Assessment Findings Jennifer Kawatu RN, MPH November 9, 2011 Our Future www.jsi.com

Purpose Provide assessment of IPP today, and make recommendations for future direction to meet the needs of the changing healthcare environment. Primary: IPP Region VIII (JSI/Denver) Secondary: IPP Infrastructures in all regions, IPP Partners, CDC To get ahead and be proactive in responding to the larger changes related to ACA www.jsi.com

Process Literature Review Data Analysis Collaborative Process 3 Surveys Key Informant Interviews National Assessment Regional Assessment Denver www.jsi.com

Region I Surveys IPP Lab Partners Survey IPP Family Planning and STD State Partners IPP Clinic Capacity Survey Most Region I findings consistent with national findings Sorry about confusion re: the three surveys – but these were the three – and they were all responded to well in Region I - www.jsi.com

Lab Partners Survey 100% participation 100% State PH Labs Primary Challenges Identified: Funding Decreased utilization of public health labs Resources – human and other The first survey…Lab Partners….Yay! – we got a 100% participation from our Lab partners – 6 out of 6! Overall, the findings were not surprising, but identified funding, and a lack of resources – including human resources, but also others – as the primary challenges – also, there was concern for an anticipated drop in specimens or utilization of PH labs that may be part of the changes that come with ACA – they may or may not happen – but it was a concern. www.jsi.com

Lab Partners (cont’d) Billing Capacity: \ Region I better prepared for billing Barriers: policy, software, resources The good news – is that in comparison to other Regions, Region I is better prepared with billing capacity – see table – The barriers, however, included policies that preclude billing, lack of software, and human resources (training/capacity) www.jsi.com

FP and STD Partners Survey All States Represented Preliminary Data only 11 Responses identified as Region I and state listed 4 FP, 7 STD, 1 other Lack of clarity about what state is doing and what future will look like Second Survey - FP and STD Partners Survey – Generally – All states (yay) Responses misclassified Many “I don’t knows” related to health information exchange and future ACA activities www.jsi.com

FP and STD Partners Survey Compared to the National Findings: More data in Region I than nationally Particularly Zip Code, language, risk, income More use of GIS – (5/11) Less Direct Service More partnerships with CHC’s, corrections, schools Less with Universities and private practices When compared to national findings, Region I has more robust data, uses more GIS (5 out of 11 said they were using) Provide less direct service, and had some differences in partnerships: More with CHC, Corrections, and M/H Schools Less with Universities and private practices www.jsi.com

FP and STD Partners Survey Barriers to Care: Particular Challenges: Transportation Teens, young adults Appointment availability Rural African American Lack of information Foreign-born Lack of awareness of services Uninsured Men EPT Linguistic barriers Partner Notification FP and STD Partners identify the following Barriers to Care: Transportation Appointment availability Lack of information Lack of awareness of services Linguistic barriers Populations with particular Challenges: Teens, young adults Rural African American Foreign-born Uninsured Men EPT Partner Notification (nationally the same except more of an emphasis on Hispanic / undocumented individuals) Particular populations / services identified as having additional challenges: www.jsi.com

FP and STD Partners Survey Primary Challenges under ACA: Funding, Funding, Funding “Institutional systems for program improvement (such as billing for services) are not in place to help offset costs” “There will need to be a lot of assistance given to local sites in order to make them a part of a safety net provider. There is little funding or staff at most sites available to address these changes.” Primary challenges expected under ACA: basically, “funding funding, funding” (read quotes) www.jsi.com

IPP Clinic Capacity Survey 56 Responses Region I 35 Family Planning, 19 STD 5 states represented Compared to U.S. clients: More white More Urban Slightly higher income (100-133% FPL) 56 Responses Region I 35 Family Planning, 19 STD 5 states represented (mis-classification may have led to wrong numbers – but 56 we are sure these were Region I) Compared to U.S. Region I clients: More white More Urban Slightly higher income (100-133% FPL predominant instead of under FPL) www.jsi.com

IPP Clinic Capacity Survey Billing Capacity More billing capacity than nationally Barriers listed as: Difficulty getting on carriers’ lists Patients uninsured anyway Lack of staff capacity for billing and coding Private Insurance Medicaid Medicaid HMO Region I 92% 90% 83% Nationally 64% 91% 67% Third Survey – Clinic Capacity – More billing capacity than nationally Barriers listed as: Difficulty getting on carriers’ lists Patients uninsured anyway Lack of staff capacity for billing and coding www.jsi.com

IPP Clinic Capacity Survey Additional notes for Region I v. National: Targeting males more (70 v. 58%) Using BD more (56% v. 14%) Using EHR more (33% v. 24%) Using Nexgen more (55% v. 20%) More partnership with CHCs (39% v. 24) www.jsi.com

Qualitative (KII) Summary Findings Safety Net Funds Necessary Necessary after ACA fully implemented because still uninsured or under-insured Still need for confidential services- “STDs are their own ball game.” Need for walk-in clinics for those without established PCPs Expect need to initially increase as more people enter the system Not all insurances will cover STI services or meds Screen males not covered by ACA On-site medications www.jsi.com

Quotes “It is better to provide care in the comprehensive care context…it is important for them to know that sexual health is part of their whole health and well-being and that it is important. They should know that their provider is knowledgeable and that sexual health shouldn’t be considered weird and separate.” – An FQHC Family Practice MD 9/9/2019 www.jsi.com

Quotes “We try to talk to the PCP to prepare them for the at-risk patients, but sometimes testing and treatment of Syphilis can take three visits and a trip to the pharmacy instead of one visit. The specialty knowledge is really important and often missing.” “People see family planning clinics as a private place. Sometimes they don’t want to go to the CHC where they might see Mom or Dad.” 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Future role of IPP: Training and Education Training PCPs to provide high quality STI and FP services Consumer and provider awareness about ACA Provide consumers with STI information Capacity Building www.jsi.com

Quotes “A major change could be the co-location of STD clinics with FQHCs. Training and funding will be necessary for this type of co-locating and integration. We will have to be very clear on recommendations and training new staff.” “There needs to be training in what the private medical model is and how to utilize it….”They (FP and CHC staff) have to think not only about their own expertise and clinic but also the private providers and what they need to know.” STD CLINIC 9/9/2019 www.jsi.com

Quotes “The PTC exists for the purpose of building capacity so to have IPP doing education is reinventing the wheel…although the PTC could be reaching more clinicians than they currently do…they could reach more in private practices. It’s a matter of funding and outreach.” “I think reaching out to a larger provider population as ‘We’re here to help with this particular issue of screening young people for chlamydia….’ I think that would be better, rather than: ‘we have tests available do you want them or not’. “ 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Future role of IPP: Data and Data Systems Provide Quality Assurance Provide Surveillance/Monitoring and Evaluation Data to sites and providers for decision making Assistance with “meaningful use” Help FP Sites to establish and/or use EMRs (CHCs got most funding for EMRs because of Medicaid population that they serve) www.jsi.com

Quotes “There has been a lack of public funding for support of infrastructure development, specifically for adoption of EMRs and the capacity to meeting “meaningful use” criteria in the public sector and this is more significant in that Title X has been underfunded a long time and there will be more need for that funding with impending change.” “There needs to be more data sharing between FP and STD…” 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Future role of IPP: Technical Assistance Help states pass State Plan Amendments for Medicaid Coverage of FP services Help understand ACA changes Help broaden FP role to be primary care Facilitate confidentiality of services Outreach and consumer education 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Challenges One of challenges and a concern is going to be greater access to insurance and greater access to care which means more screening and more positives. Concern that we don’t have the infrastructure to support this. Especially in terms of direct service we will see saturation. STD clinics survival - 60-80% of the clinics are not capable of third-party billing. 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Challenges IPP needs to be standardized …easier to participate and less administrative burden. There is a lot of administrative burden in receiving federal funds. Streamline program from an operations standpoint. There are a lot of steps to make free tests happen. 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Strengths of IPP Come together and talk and understand trends in other states. IPP was the leader for us. We’ve been looking at timeliness of treatment, PID and concentration on rescreening and these are strengths of IPP. More than just providing free testing-impactful in terms of standardization and providing information to the provider community www.jsi.com

Quotes “There is a lot of administrative burden in receiving federal funds and if this can be assisted it will help facilitate transition.” “It is very hard to blend public health and private medical bureaucracy requirements…” “I think there’s a role for IPP (post ACA) but I think it needs to be repurposed and it needs to include men.” 9/9/2019 www.jsi.com

Qualitative (KII) Summary Findings Strengths of IPP cont. Public health labs also tend to work with colleagues – our IPP group here – and try to keep up with what is going on nationally in terms of best practices and trends. Connection to the federal level for IPP and ACA Material development www.jsi.com

Qualitative (KII) Summary Findings Strengths of IPP cont. Information exchange/facilitate communication/mutual learning/relationship building IPP could be another public health program that doesn’t provide direct services; however, this direct service component is IPP’s strength. 9/9/2019 www.jsi.com

Quotes “The regional infrastructure has helped us coordinate regionally as well as observe trends, but really it has been a vehicle for us to come together and talk and understand trends in other states – especially trends with a focus on preventing infertility” “IPP has been impactful in terms of standardization…(knowledge sharing, communication) it is so much more than free tests…” Chlamydia Region I IPP 9/9/2019 www.jsi.com

Thank you to everyone for your participation! The Future: Thank you to everyone for your participation! www.jsi.com