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  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

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

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

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%)

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.

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.

Prescriptions to Identify Contraceptives Description  desogestrel-ethinyl estradiol, 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,mestrano l-norethindrone  Diaphragm  diaphragm  Spermicide  nonxynol 9

Codes to Identify Sexually Active Women Description Codes  CPT , 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, , , 59866, 59870, 59871, 59897, 59898, 59899, 76801, 76805, 76811, 76813, , , 76941, , 80055, 81025, 82105, 82106, 82143, 82731, 83632, , 84163, , , , 87110, 87164, 87166, 87270, 87320, , , , 87660, 87800, 87801, 87808, 87810, 87850, , 88147, 88148, 88150, , , , 88235, 88267,  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, , , , , , , 079.4, , , , , 098.0, , , , 098.2, , , , 099, 131, , 622.3, 623.4, 626.7, 628, , 795.0, 795.1, , 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,  UB Revenue 0112, 0122, 0132, 0142, 0152, , 0724, 0729, 0923, 0925

How Compliant are Providers with Annual Chlamydia Screening? Age (yrs) Commercial HMO (%) Medicaid HMO (%) Health Plan Type _____ ________________ ____________ The State of Health Care Quality, 2011 National Center for Quality Assurance at: Chlamydia Screening HEDIS Rates

HEDIS Chlamydia Screening Rates

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

Second Foray: Presenting at HEDIS Best Practices Conferences  Annual meeting held on each coast  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

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

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

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

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)

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

CAN

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