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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 - PowerPoint PPT Presentation
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COLLABORATION AND CHLAMYDIA
Susan DeLisle, ARNP, MPHNational Chlamydia CoalitionProvider 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,mestranol-norethindrone
Diaphragm diaphragm Spermicide nonxynol 9
Codes to Identify Sexually Active Women Description Codes 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, 88174-88175, 88235, 88267, 88269
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, 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, 098.35-098.8, 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
ICD-9-CM Procedure 69.01, 69.02, 69.51, 69.52, 69.7, 72-75, 88.78, 97.24, 97.71, 97.73
UB Revenue 0112, 0122, 0132, 0142, 0152, 0720-0722, 0724, 0729, 0923, 0925
How Compliant are Providers with Annual Chlamydia Screening?
16-20 41.1 53.5
21-24 49.2 63.6
Age (yrs) Commercial HMO (%) Medicaid HMO (%)
Health Plan Type
_____ ________________ ____________
The State of Health Care Quality, 2011National Center for Quality Assurance at: http://www.ncqa.org/LinkClick.aspx?fileticket=J8kEuhuPqxk%3d&tabid=836
2012 Chlamydia Screening HEDIS Rates
HEDIS Chlamydia Screening Rates
2006 2008 2010 20120
10
20
30
40
50
60
36.2
40.1 40.8 41.1
29.4
37.7 38.1 38.9
50.552.7
54.6 53.5
16-20 Years
Commercial HMOCommercial PPOMedicaid HMO
Perc
enta
ge S
cre
ened
HEDIS Chlamydia Screening Rates
2006 2008 2010 20120
10
20
30
40
50
60
70
38
43.545.7
49.2
31.2
39.441.9
45.5
55
59.462.3 63.6
21-24 Years
Commercial HMOCommercial PPOMedicaid HMO
Perc
enta
ge S
cre
ened
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 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
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
THANK YOU
