Increasing Screening in the Private Sector Task Force Gale R Burstein, MD, MPH, FAAP Medical Director Epidemiology and Surveillance and STD & TB Control.

Slides:



Advertisements
Similar presentations
Clinical Alliances and Partnerships Raul A. Romaguera, DMD, MPH Division of HIV/AIDS Prevention Centers for Disease Control and Prevention March 11, 2004.
Advertisements

March 29, 2012 Improving Health Outcomes for Children in Foster Care: the Role of Electronic Information Exchange.
School-Based Health Care 101 Understanding the Basics 1.
813 Wake County Lessons Learned and What’s to Come.
Assessing the Training Needs of Managed Care Providers: Implications for STD Clinical Training Targeting this Hard-to- Reach Group by the Eastern Quadrant.
CDC Recommendations for HIV Testing of Adults and Adolescents Christina Price, MPH Delta Region AIDS Education and Training Center.
Innovative Approaches to Screen School Populations for Sexually Transmitted Infections Paritosh Kaul, MD Douglas B Richardson Gerrit Bruintjes Cornelis.
CFP Information Call: Addressing Policy Barriers for State and Local Health Departments when Implementing the PCSI Strategy Audio Instructions: ,
Field Based Treatment of Chlamydia and Gonorrhea Nilmarie Guzmán,MD & Michael Sands,MD University of Florida/Jacksonville and the Duval County Health Department.
Self-Collected Vaginal Specimens for the Detection of Multiple STIs in Adolescent Detainees Cynthia M. Holland, M.D., M.P.H., Harold C. Wiesenfeld, M.D.,
Revision of Region II IPP Screening Criteria May 16, 2007 Region II IPP Advisory Committee Meeting Cicatelli Associates Inc. New York City.
DC American Academy of Pediatrics Adolescent Health Working Group Expedited Partner Therapy Fact Sheet Updated February 20, 2014 DC American Academy of.
New Employee Orientation
Adolescent HIV In Metro Atlanta: Updates & Opportunities.
Screening Rates Before and After the Introduction of the Chlamydia HEDIS Measure in a Managed Care Organization GR Burstein 1, MA Snyder 2, D Conley 2,
African Americans and HIV: CA Office of AIDS Response Michelle Roland, MD Chief, Office of AIDS California Department of Public Health.
Using Qualitative Data to Contextualize Chlamydia and Birth Rates Joyce Lisbin EdD, Anna Groskin MHS, Rhonda Kropp RN MPH, Virginia Loo ABD, Julie Lifshay.
CFP Information Call: Policy Impacting Youth Access to Reproductive and Sexual Health Services from Schools Audio Instructions: , pass code:
PATHWAYS TO SCHOOL READINESS IN NASSAU COUNTY: Improving Developmental Screening, One Clinic at a Time.
California Dental Association Legislative Update Policy Initiatives October 2006.
Staff Spark 3: Confidentiality and Minor Consent – Best Practices
10 Questions for Health Departments When Assisting Schools and DOEs Kurt Conklin, MPH, CHES School Health Project Coordinator, SIECUS.
1 Advancing Recovery: Baltimore Buprenorphine Initiative Tucson Presentation July 29, 2009 Baltimore Substance Abuse Systems.
Health Care Reform and Adolescent Health Service Delivery: Principles and Principals Richard E. Kreipe MD, FAAP, FSAM Society for Adolescent Medicine (SAM)
StopSTDs! Improving Prevention and Screening in Young People BlueShield of Northeastern New York Capital District Physicians' Health Plan Albany Medical.
Multifaceted HPV Vaccination Strategies in California Achieving the Promise Avoiding the Pitfalls Heidi M. Bauer, MD MS MPH California Department of Public.
The Needs of Pediatric Practices for Policy and Procedures to Facilitate Youth with Special Health Care Needs (YSHCN) Transition to Adulthood. Patience.
Southwest Community Health Center “Caring for Community” A non-profit, community health center providing primary care, health education, and advocacy for.
Agency: Planned Parenthood of Delaware Intern: Bevin Hileman.
Slide 1 Barriers and Facilitations to HIV Testing in Private Care Settings Michael Horberg, MD MAS FACP Director, HIV/AIDS Kaiser Permanente Clinical Lead,
State Alliance for e-Health Conference Meeting January 26, 2007.
Chapter Quality Network (CQN) Asthma Pilot Project Our Now and Our Future James C. Wiley, MD, FAAP CQN Chapter Physician Leader Alabama Chapter-AAP President.
Resources to Improve Private-Sector Providers Chlamydia Screening Practices Gale R Burstein, MD, MPH, FAAP Erie County Department of Health Buffalo, NY.
State and Local STD Prevention Programs Prepared by Jim Lee, Senior Public Health Advisor, Texas Department of State Health Services and Melinda Salmon,
Universal Screening for Lynch Syndrome with Cascade Screening for Relatives September 7, 2012 Deb Duquette, MS, CGC Michigan Department of Community Health.
Hispanics & Health Disparities Summit Series Recommendations National Hispanic Medical Association U.S. Department of Health and Human Services Office.
Lower Hudson Valley Perinatal Network Serving Dutchess, Putnam, Rockland & Westchester Counties Presented at the Quarterly Education & Networking Conference.
Put Prevention Into Practice. Understand the PPIP Program What is Put Prevention Into Practice (PPIP)? What is Put Prevention Into Practice (PPIP)? Why.
Region II IPP Data & Infrastructure Performance Measures Kelly Opdyke, MPH Region II IPP Advisory Committee Mtg May 16-17, 2007 Cicatelli Associates Inc.
Integration of Male Services into Family Planning Settings April 4, 2006 Norman Clendaniel Delaware Division of Public Health.
Ryan White All Grantees Meeting Washington, DC November, 2012 Supporting National HIV/AIDS Strategies: the domestic experience and the AETCs.
Reaching Adolescents Michigan’s Infertility Prevention Screening Project.
Barriers to Providing Health Services for HIV/AIDS, Hepatitis C Virus Infection, and Sexually Transmitted Infections in Substance Abuse Treatment Programs.
Sara Lovell, CPCS Education Coordinator Providence Alaska Medical Center.
HIV/STD Partner Services Recommendations Cindy Getty & Rheta Barnes Divisions of HIV/AIDS Prevention & STD Prevention National Centers for HIV/AIDS, Viral.
In-Reach Program Elizabeth Keck, MSW, LGSW Allina Health - Owatonna Hospital May 19, 2014 Participants: , no code needed.
In-Reach Hospital Program In-Reach Hospital Program Coordinating Multiple Service Providers Rare Presentation Partnership between: South Central Human.
California Department of Public Health Office of AIDS HIV CARE and PREVENTION 2009: You Need to Know.
1 WOMEN AND HEALTH REFORM: LESSONS FROM MASSACHUSETTS November 9, 2010 American Public Health Association Annual Meeting Tracey Hyams, JD, MPH, Director.
Canadian Best Practice Recommendations for Stroke Care Recommendation 1: Public Awareness and Patient Education (Updated 2008)
CT and GC Screening: What about the guys?! Gale R Burstein, MD, MPH, FAAP, FSAHM Erie County Department of Health SUNY at Buffalo School of Medicine Buffalo,
If you build it, will they come? The APICHA HIV Primary Care Clinic: From inception to strategic expansion Victor K. Inada, MD—Medical Director, APICHA.
Increased # of AI/AN receiving in- home environmental assessment and trigger reduction education and asthma self-management education Increased # of tribal.
IPP Infrastructure Measures of Effectiveness: Preliminary Data and Next Steps Kelly Morrison Opdyke, MPH Region II Infertility Prevention Project Cicatelli.
Promoting Science-based Approaches to Preventing Teen Pregnancy, STDs and HIV Policy, Partnerships, and Creativity Brigid Riley, MPH American Public Health.
Check Your Risk: Increasing School-Based STI Screening Participation Among District of Columbia High School Students Michelle Jasczyński, Ed.M. Public.
Public Health Safety Net for Commercially Insured Adolescents Seeking Confidential Reproductive Health Services Dawn Middleton, BS Region II Infertility.
Can Providers Assure Commercially Insured Adolescents Confidentiality for STI Screening and Treatment? C onflicting Laws and Innovative Approaches Abigail.
ADOLESCENTS Strengthening Systems for Diagnosis of HIV & Linkage to Care Institute of Medicine April 15-16, 2010 Donna Futterman, MD | AdolescentAIDS.org.
Neighborhood-Based Public Health Program to Reduce Teen Pregnancy Disparities in NYC Allyna B. Steinberg, MPH Philip M. Alberti, PhD Bronx District Public.
Getting to the second 90 in adolescent HIV: What is needed
PRACTITIONERS, AND PHYSICIAN ASSISTANTS
Implementation Issues for HPV Vaccine
Conflicting Laws and Innovative Approaches
Collaborative Efforts in California to Prepare for the HPV Vaccine
Sustaining Primary Care-Public Health Partnerships for Engagement in Care – The Partnerships for Care Demonstration Project Sue Lin, PhD, MS Director,
IPP Coordinator’s Update
Indiana Traumatic Brain Injury State Plan 2018 – 2023
March 8, 2006 New ACIP Hepatitis B Recommendations
Presentation transcript:

Increasing Screening in the Private Sector Task Force Gale R Burstein, MD, MPH, FAAP Medical Director Epidemiology and Surveillance and STD & TB Control Erie County Department of Health Buffalo, New York November 1, 2006

Adolescent STI Services: Challenges and Opportunities Health systems level Provider level Patient (adolescent) level

Adolescent STI Services: Challenges and Opportunities Systems Level

Systems Level: Opportunities New opportunities for routine non-invasive STI testing Urine nucleic acid amplification tests (NAATs) for STIs New Pap smear guidelines – 1 st Pap at 3 years after start sex or at 21 years old Chlamydia testing sexually active year old females is HEDIS measure

Systems Level: Opportunities All 50 states and D.C. have laws allowing minors right to consent for STI testing and treatment 30 states include HIV testing and treatment in STI services to which minors may consent Federal funding for STI testing and care

A minor (person <18 yrs), may be counseled, tested and treated for STIs without a parent or guardian's consent, as long as the minor understands the risks and benefits of the proposed and alternative treatments. “Information about STIs cannot be released to parents or guardians without the patient’s permission.” New York State Minors Reproductive Rights Law

Systems Level: Challenges NYS Insurance Law Section 3234 Mandates that health insurance companies provide to their members/subscribers an explanation of benefits (EOB) statement following a filed claim under any policy providing hospital or medical expense benefits (Circular Letter No. 7, March 24, 2005). EOB must contain information about the date, cost and scope of health care services received. no exception relating to the age of the member receiving the service or the nature of that service.

Systems Level: Challenges $$$$$$$$ Adolescent age group most likely to be uninsured Copayments may be barrier for youth receiving care How to bill for “confidential” health care services? Explanation of Benefits may result in disclosure to parent Difficult to bill for sexual health services More time in visit not reimbursed Cannot bill for “first” pelvic exam

Systems Level: Challenges Access/Availability Health plans may not offer urine STI NAAT tests Many providers do not offer STI services Limited time available for health care visit Limited provider office hours Adolescent access to transportation

Adolescent STI Services: Challenges and Opportunities Provider Level

Provider Level: Knowledge Not aware of non-invasive STI test options new urine chlamydia NAATs New Pap test guidelines Unfamiliar with minors’ rights to consent for STI care Lack of STI clinical training Unclear how to bill for confidential STI services

Provider Level: Skill Many not skilled or comfortable offering confidential sexual health services to adolescents Performing an “atraumatic parentectomy” Discussing sexual health, including sexual activity information

Provider Level: Beliefs Assume that chlamydia is not a health problem in their adolescent patient population Low priority and lack of time Perceive inadequate reimbursement and financial disincentives for providing sexual health services

Adolescent STI Services: Challenges and Opportunities Adolescent Patient Level

Patient Level: Knowledge Teens unaware of need for preventive health care services Lack of knowledge regarding STIs Most have no symptoms Usually need a test to identify infection

Patient Level: Beliefs Falsely perceive low STI-risk stigma Perceive primary care provider does not want to address sexual health needs Health care is a low priority Believe cannot receive confidential services

Is this hopeless????

Providing Confidential Care for Adolescent Healthcare in Primary Care Settings A Region II Infertility Prevention Project Demonstration Project Partnership with the Foundation for Healthy Living

The Foundation For Health Living (FHL), Albany, NY Non-profit, 501(c)3 health services and research foundation Mission to increase and disseminate knowledge about health care and improve health of NYS residents. Affiliated with HealthNow New York, Inc. Blue Cross Blue Shield subsidiary A leading NYS health plan Serves members from over 53 counties in Upstate NY

Providing Confidentiality for Adolescent Health Care: A Demonstration Project 1)Develop a consensus statement on adolescent confidentiality in health care in private practice settings 2)Develop a set of recommendations for the NYSDOH and NYS Insurance Department to address gaps in adolescent confidentiality in the provision of STI-related care for commercially insured clients in private practice settings.

Providing Confidentiality for Adolescent Health Care Advisory Work Group Comprised of adolescent health care stakeholders NYSDOH New York State Insurance Department health plans prominent pediatricians adolescent health physicians

PCAHC Demonstration Project Objectives To better understand the need for confidential adolescent health care Identify barriers to confidential adolescent health care Review the current legal and regulatory state as it pertains to confidential adolescent health care Propose a series of recommendations for short and long term solutions to remove barriers Collate and disseminate findings from proceedings. Wherever possible, facilitate translation of outcomes and products for use throughout the nation.

PCAHC Demonstration Project Activities Create an advisory work group of medical, health and policy experts Identify national experts who will help inform workgroup activities Convene 2 PCAHC meetings Stakeholders will convene meetings with local stakeholders to vet recommendations Review the NYS Reproductive Minor’s Right’s Law Review reproductive health recommendations from professional medical societies, adolescent health providers and advocacy organizations Consider the unique barriers related to the provision of confidential reproductive health services for commercially insured adolescents Assess model provider-patient confidentiality tools across the country Consider educational interventions and materials tailored to health care providers, parents and adolescents

PCAHC Demonstration Project Outcomes Develop consensus statement on adolescent confidentiality in health care Provide recommendations to NYSDOH and Insurance Department to address gaps in adolescent confidentiality Publish and disseminate findings, lessons learned and recommendations, emphasizing both local and national implications. Conduct assessment among identified health plans to determine if they made or plan to make any changes related to the provision of confidential STD-related care as a result of demonstration project recommendations.