Presentation - National Chlamydia Coalition

Report
COLLABORATION AND
CHLAMYDIA
Susan DeLisle, ARNP, MPH
National Chlamydia Coalition
Provider Education Committee
National Chlamydia Coalition (NCC)
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Formed in 2008
Comprised of over 40 organizations
Health care professional organizations
 Insurers
 Non-profit organizations
 Local, state, federal government representatives
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Managed by Partnership for Prevention
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Funded by the Centers for Disease Control and Prevention
Mission
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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?
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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)
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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?
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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
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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
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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.
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Ages: Women 16–24 years as of December 31 of the
measurement year. Report two age stratifications and a
total rate.
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Commercial, Medicaid (report each product line separately)
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
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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
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desogestrel-ethinyl estradiol,
drospirenone-ethinyl,
lestradiol,estradiolmedroxyprogesterone
ethinyl estradiolethynodiol,ethinyl
estradiol-etonogestrel,ethinyl
estradiol-norethindrone
ethinyl estradiol, norgestimate,
ethinyl estradio,l-norgestrel,
etonogestrel
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Levonorgestre, ethinyl estradiollevonorgestrel,ethinyl estradiolnorelgestromin
Medroxyprogesterone,mestrano
l-norethindrone
Diaphragm
diaphragm
Spermicide
nonxynol 9
Codes to Identify Sexually Active
Women Description Codes
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CPT
11975-11977, 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, 59850-59852, 59855-59857, 59866, 59870, 59871, 59897, 59898, 59899, 76801, 76805,
76811, 76813, 76815-76821, 76825-76828, 76941, 76945-76946, 80055, 81025, 82105, 82106,
82143, 82731, 83632, 83661-83664, 84163, 84702-84704, 86592-86593, 86631-86632, 87110,
87164, 87166, 87270, 87320, 87490-87492, 87590-87592, 87620-87622, 87660, 87800, 87801,
87808, 87810, 87850, 88141-88143, 88147, 88148, 88150, 88152-88155, 88164-88167, 8817488175, 88235, 88267, 88269
HCPCS G0101, G0123, G0124, G0141, G0143-G0145, G0147, G0148, H1000, H1001, H1003H1005, P3000, P3001, Q0091, S0180, S0199, S4981, S8055
ICD-9-CM Diagnosis 042, 054.10, 054.11, 054.12, 054.19, 078.11, 078.88, 079.4, 079.51-079.53,
079.88, 079.98, 091-097, 098.0, 098.10, 098.11, 098.15-098.19, 098.2, 098.30, 098.31, 098.35098.8, 099, 131, 614-616, 622.3, 623.4, 626.7, 628, 630-679, 795.0, 795.1, 996.32, 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
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ICD-9-CM Procedure
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UB Revenue
69.01, 69.02, 69.51, 69.52, 69.7, 72-75, 88.78, 97.24, 97.71, 97.73
0112, 0122, 0132, 0142, 0152, 0720-0722, 0724, 0729, 0923, 0925
How Compliant are Providers with Annual
Chlamydia Screening?
2012 Chlamydia Screening HEDIS Rates
Health Plan Type
Age (yrs)
_____
Commercial HMO (%) Medicaid HMO (%)
________________
____________
16-20
41.1
53.5
21-24
49.2
63.6
The State of Health Care Quality, 2011
National Center for Quality Assurance at: http://www.ncqa.org/LinkClick.aspx?fileticket=J8kEuhuPqxk%3d&tabid=836
HEDIS Chlamydia Screening Rates
16-20 Years
60
54.6
52.7
50.5
53.5
Percentage Screened
50
40
30
37.7
36.2
41.1
40.8
40.1
38.1
38.9
Commercial HMO
29.4
Commercial PPO
Medicaid HMO
20
10
0
2006
2008
2010
2012
HEDIS Chlamydia Screening Rates
21-24 Years
70
63.6
62.3
59.4
60
55
49.2
Percentage Screened
50
45.7
43.5
40
39.4
38
45.5
41.9
Commercial HMO
31.2
Commercial PPO
30
Medicaid HMO
20
10
0
2006
2008
2010
2012
First Foray: Approaching the NCQA
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Chlamydia screening recognition program?
Deemed too narrow
 Might consider “sexual health” umbrella
 HPV vaccine pre sexual activity
 Pap smear screening (at 90%)
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Treatment measure?
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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
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Take Away Message: Primary problem is obtaining
the initial screening test
Second Foray: Presenting at HEDIS Best
Practices Conferences
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Annual meeting held on each coast
200-300 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
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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
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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
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Topics
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Session I – Current News, on Chlamydia, Screening
Measure, Specifications, and Performance
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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
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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)
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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
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What Else To Do?
“There’s something for everyone”
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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)
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Health plans are very competitive
Explore health plan websites looking for NCQA
accreditation or certification recognition
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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”
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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
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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
THANK YOU

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