1 Infertility Prevention Project Region I Advisory Board Meeting Lessons Learned In Michigan Amy Peterson, MPH Michigan Department of Community Health June 1, 2009

2 Presentation Topics oMichigan Background oQuick and Dirty Cost Savings Analysis oUse of Cost Saving Information oMichigan IPP Program Management oTargeted Expansion oGonorrhea/Chlamydia Reduction Plan oProgram Expansion and Contraction

3 Michigan Background

44 Gonorrhea and Chlamydia Burden in Michigan o46,555 reported cases of chlamydia o77% age ≤ 24 o17,905 reported cases of gonorrhea o66% age ≤ 24 o * All numbers reflect CY 2008

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7 Michigan IPP Tie-Dye oQuarterly Alliance Meetings oSTD oFP oBureau of Labs oAdolescent Health oOakland County oJuvenile Detention

88 IPP Screening Activity oCalendar Year 2008 o~ 105,000 ( 104,621 ) screened for chlamydia oOver 10.3% ( 10,789 ) found positive o75% of positives are yrs/age (63% of tests) o~ 90,000 ( 91,835 ) screened for gonorrhea o4.2% ( 3,840 ) found positive o61% of all positives are yrs/age (58% of tests) oDiagnose ~23% of the State’s morbidity

9 Quick and Dirty Cost Savings Analysis

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11 Funding for IPP Activity oSTD oFederal IPP (tests/administration) oState General Fund/Michigan Health Initiative (tests/administration) oLocal Public Health Operating funds (staff) oLocal health jurisdiction funding (staff) oFamily Planning oTests and Plan First!/Medicaid oAdolescent and School Health Program oTests/coordinating consultant

12 Cost Savings Analysis oBegan as a way to avoid cuts during 2007 budget crisis oGood PR tool for all stakeholders oLocal Health Jurisdiction – IPP analysis oMedicaid cost analysis

13 Steps in Michigan’s Unscientific Formula oIdentify number of FEMALES diagnosed with CT and/or GC in population of choice (IPP, total morbidity, persons on Medicaid, etc) oApply CDC statement – undiagnosed 30-40% may progress to PID oMultiply # positives times.40, times cost of treating a case of PID (multiple reference articles available). oAdd disclaimers and footnotes oUse terms like “estimated” and “expected” frequently

14 Medicaid Cost Savings Analysis oTwo calculations: 1.Estimated amount saved based on avoided PID at current screening level 2.Cost to treat cases of PID which could have been avoided with 100% screening of eligible patients

15 Medicaid Analysis Data Sources oRequested data from Michigan Medical Services Administration, Data Analysis and Quality Assurance Section (MSA) oNumber screened was gathered from the Medicare Managed Care Annual Report oReceived number diagnosed with PID by race from MSA – based on diagnosis code oMSA 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. oSee handout for details

16 Missed Screening Opportunities Cost Michigan Money oAmount spent by Medicaid to screen female members age in 2006 – o ~ $2.2 million oCost to screen and treat 100% of eligible Medicaid female members age in o ~ $4 million oCost to treat chlamydia related PID in 2006 – o ~ $5.5 million

17 Projected cost/savings in 2012 (shown in millions) Screening for CT is a good investment

18 Cost Savings Analysis as Advocacy Tool oGarnering good will with screening partners and their upper level administrators oBuild case for additional funding from State; proven cost savings for Medicaid oAdvocate to keep resources based on “Evidence Based”, “Cost-Effective Public Health Strategy” o$ adds power to sound bites

19 Michigan’s IPP Program Management

20 Program Management oPre-Paid Forms oCT-only Testing Algorithm oConstant Monitoring of Usage

21 Pre-Paid Forms oSee handout

22 CT-only Testing Algorithm: Targeted Use of Resources oSee Handout

23 Constant Monitoring of Utilization oMonitored semi-annually oRobin Hood approach to test re-allocation

24 Targeted Expansion

25 Juvenile Detention/ Adolescent Health Expansion o2002 – RVIPP Mini-grant to target juvenile detention oChildren’s Village/ Lynda Byer oJD sites in high morbidity counties approached oSchool based health centers – Oakland oStatewide expansion with Carrie Tarry

26 Wayne County Juvenile Detention oOver two years of trying, asking, begging oMultiple staff and attempts oNew Medical Director – Dr. Carla Scott oFull implementation July 2006 o01/08 – 12/08 (paid for ½ of tests themselves) o3,771 tested 770 F; 3001 M o424 + CT (22% F, 9% M) o87 + GC (6% F, 1.3% M)

27 Expansion and Contraction

28 Dream Big… oFocus on mission of program oAcknowledge uncomfortable decisions that come with limited resources oChallenge politics as usual oTarget non-traditional partners oTarget services to address health disparities (not just racial) oLook for yield from every test supported

29 Gonorrhea/Chlamydia Reduction Plan

30 52,673* cases per year 144 new infections per day removing 144 infections per day Status Quo: gonorrhea and chlamydia in Michigan * Average

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

32 Evidence Based Components of the Plan 1.Increase school-based screening 2.Implement universal screening of males in STD sites 3.Increase private sector screening 4.Support alternative site high-risk screening

33 Evidence Based Components of the Plan 5.Implement CDC re-testing guideline 6.Utilize electronic medium to notify partners 7.Encourage field-delivered therapy for identified cases 8.Improve partner management in public and private sector

34 Targeted Expansion – 2009 Pilot Projects in High Morbidity Areas oSchool Blitz (8.3/11.9) oTeen Health Centers (19 CT, 5.2 GC) oWayne County Jail (10 CT, 3 GC) oPregnancy Test Only (10.2 vs. 7.5) oUniversity Dorms (15 CT, 3.3 GC) oFederally Qualified Health Center – STD Overflow (11 CT, 4 GC) oExpanded Screening Initiative (ESI) Grants oRetesting oUniversal male screening in STD Clinics

35 Likely Targeted Contraction oMaintaining screening criteria age limit at 24 years old oState support of health center screening at Oakland University – likely discontinued (6 / 9 CT) oESI Grants – support for testing only oDiscontinue universal male screening in STD clinics

36 Targeted Contraction oReviewing Adolescent Health and Family Planning sites ocutting low prevalence sites to minimum oencouraging billing Medicaid and “Plan First!” when possible (50% estimated) odrill down analysis to ID who is testing positive and providing guidance oShifting resources to high prevalence sites

37 Calling on Our Partners in 2010 oAdolescent health picking-up larger portion of costs oTargeted expansion to two new screening sites in high prevalence sites oFamily Planning willing to make hard calls with low positivity sites oIncrease attention to private sector (Nancy). Using LPH partners to increase knowledge and action among local providers

38 No/ low cost program improvements oSchool blitz guidance oMessages to private sector through managed care organizations to increase attention to HEDIS measure oRe-test in current sites oField delivered therapy guidance oWork with IPP providers to increase partner management capacity and intentions

3939 Questions…Contact Amy Peterson IPP Coordinator Michigan Department of Community Health STD Program