1. Effort to Initiate a Chlamydia Prevalence Study within a Managed Care Organization in Philadelphia Pamela G. Nathanson, Dorothy Mann Family Planning Council, Inc. Philadelphia, PA

2. Background Region III Chlamydia Project Advisory Committee expressed interest in determining chlamydia positivity in private sector. Region III Chlamydia Project Advisory Committee expressed interest in determining chlamydia positivity in private sector. Little data existed on prevalence in commercial managed care organizations. Little data existed on prevalence in commercial managed care organizations. Family Planning Council and CDC partnered to initiate a prevalence study in a managed care organization in Philadelphia. Family Planning Council and CDC partnered to initiate a prevalence study in a managed care organization in Philadelphia.

3. Objectives Describe the process of working with a large MCO to develop a prevalence study. Describe the process of working with a large MCO to develop a prevalence study. Describe successes and challenges encountered in working with the MCO to implement the study. Describe successes and challenges encountered in working with the MCO to implement the study. Explore potential next steps. Explore potential next steps.

4. The Players Family Planning Council – Administrative body for the Region III Chlamydia Project. Family Planning Council – Administrative body for the Region III Chlamydia Project. Centers for Disease Control and Prevention – Division of STD Prevention, Health Services Research and Evaluation Branch. Centers for Disease Control and Prevention – Division of STD Prevention, Health Services Research and Evaluation Branch. Independence Blue Cross – largest network plan in Southeastern Pennsylvania. Independence Blue Cross – largest network plan in Southeastern Pennsylvania.

5. The Process Initial contact was made with OB/Gyn Medical Director at IBC who had already expressed interest in improving their STD services. Initial contact was made with OB/Gyn Medical Director at IBC who had already expressed interest in improving their STD services. Meetings/conference calls held with OB/Gyn and overall Medical Directors to discuss development of study. Meetings/conference calls held with OB/Gyn and overall Medical Directors to discuss development of study. Initial protocol drafted by CDC. Initial protocol drafted by CDC. Potential funding sources identified. Potential funding sources identified.

6. Purpose of the Study Determine the prevalence of chlamydia among commercially insured women ages 20-25 receiving care in private ob/gyn offices. Determine the prevalence of chlamydia among commercially insured women ages 20-25 receiving care in private ob/gyn offices. Use the results to increase the rate of chlamydia screening by improving provider compliance with existing screening protocols. Use the results to increase the rate of chlamydia screening by improving provider compliance with existing screening protocols.

7. The Proposed Study Provide cervical NAAT chlamydia screening to all women ages 20-25 undergoing pelvic exams in selected IBC Ob/gyn offices. Provide cervical NAAT chlamydia screening to all women ages 20-25 undergoing pelvic exams in selected IBC Ob/gyn offices. Collect data on DOB, race/ethnicity, zip code, provider code, test result. Collect data on DOB, race/ethnicity, zip code, provider code, test result. Determine prevalence by provider. Determine prevalence by provider. Study to run for six months. Study to run for six months.

8. Successes Initiated contact – got the issue somewhere on the radar screen. Initiated contact – got the issue somewhere on the radar screen. Generated interest in supporting the study – CDC, Pfizer, Roche Diagnostics Generated interest in supporting the study – CDC, Pfizer, Roche Diagnostics Learned more about IBC administrative and logistical operations, especially data and laboratory organization. Learned more about IBC administrative and logistical operations, especially data and laboratory organization.

9. Stumbling Blocks Lack of understanding of the disease Lack of understanding of the disease Medical Director was unfamiliar with the asymptomatic nature of CT, high prevalence rates, and sequelae. Medical Director was unfamiliar with the asymptomatic nature of CT, high prevalence rates, and sequelae. Lack of concern about downstream costs Lack of concern about downstream costs In spite of prior cost-effectiveness data, IBC not concerned about paying for treatment of PID and other sequelae in the future. In spite of prior cost-effectiveness data, IBC not concerned about paying for treatment of PID and other sequelae in the future. Little consequence of HEDIS measure Little consequence of HEDIS measure Sense that purchasers are not concerned about chlamydia screening. Sense that purchasers are not concerned about chlamydia screening.

10. Stumbling Blocks No connection acknowledged between knowing prevalence and changing physician behavior. No connection acknowledged between knowing prevalence and changing physician behavior. Contract laboratory not interested in collaborating in the study – very interested in charging high prices for testing. Contract laboratory not interested in collaborating in the study – very interested in charging high prices for testing. Concern about liability Concern about liability Medical Director feared that patients would be resistant to screening, and that this liability would not be outweighed by the benefits Medical Director feared that patients would be resistant to screening, and that this liability would not be outweighed by the benefits

11. Conclusions Chlamydia screening is not important to the plan – still not on the radar screen. Chlamydia screening is not important to the plan – still not on the radar screen. HEDIS measure is not enough of a motivator – plan sees no consequences of a score of less than 20% on the HEDIS measure. HEDIS measure is not enough of a motivator – plan sees no consequences of a score of less than 20% on the HEDIS measure. Chlamydia is a small ticket item for the plan – little motivation to make a change. Chlamydia is a small ticket item for the plan – little motivation to make a change.

12. Next Steps Region III exploring barriers to screening among commercial MCOs in the region. Region III exploring barriers to screening among commercial MCOs in the region. Planning to conduct a chlamydia prevalence study among private physician groups rather than working through health plans. Planning to conduct a chlamydia prevalence study among private physician groups rather than working through health plans. Hope to use data gathered to help plans increase screening efforts and improve performance on HEDIS measure. Hope to use data gathered to help plans increase screening efforts and improve performance on HEDIS measure.