Effort to Initiate a Chlamydia Prevalence Study within a

Managed Care Organization in Philadelphia

Pamela G. Nathanson, Dorothy MannPamela G. Nathanson, Dorothy Mann

Family Planning Council, Inc.Family Planning Council, Inc.

Philadelphia, PAPhiladelphia, PA

Background Region III Chlamydia Project Advisory Region III Chlamydia Project Advisory

Committee expressed interest in Committee expressed interest in determining chlamydia positivity in private determining chlamydia positivity in private sector.sector.

Little data existed on prevalence in Little data existed on prevalence in commercial managed care organizations.commercial managed care organizations.

Family Planning Council and CDC Family Planning Council and CDC partnered to initiate a prevalence study in a partnered to initiate a prevalence study in a managed care organization in Philadelphia.managed care organization in Philadelphia.

Objectives

Describe the process of working with a Describe the process of working with a large MCO to develop a prevalence study.large MCO to develop a prevalence study.

Describe successes and challenges Describe successes and challenges encountered in working with the MCO to encountered in working with the MCO to implement the study.implement the study.

Explore potential next steps.Explore potential next steps.

The Players

Family Planning Council – Administrative Family Planning Council – Administrative body for the Region III Chlamydia Project.body for the Region III Chlamydia Project.

Centers for Disease Control and Prevention Centers for Disease Control and Prevention – Division of STD Prevention, Health – Division of STD Prevention, Health Services Research and Evaluation Branch.Services Research and Evaluation Branch.

Independence Blue Cross – largest network Independence Blue Cross – largest network plan in Southeastern Pennsylvania.plan in Southeastern Pennsylvania.

The Process Initial contact was made with OB/Gyn Initial contact was made with OB/Gyn

Medical Director at IBC who had already Medical Director at IBC who had already expressed interest in improving their STD expressed interest in improving their STD services.services.

Meetings/conference calls held with Meetings/conference calls held with OB/Gyn and overall Medical Directors to OB/Gyn and overall Medical Directors to discuss development of study.discuss development of study.

Initial protocol drafted by CDC.Initial protocol drafted by CDC. Potential funding sources identified.Potential funding sources identified.

Purpose of the Study

Determine the prevalence of chlamydia Determine the prevalence of chlamydia among commercially insured women ages among commercially insured women ages 20-25 receiving care in private ob/gyn 20-25 receiving care in private ob/gyn offices.offices.

Use the results to increase the rate of Use the results to increase the rate of chlamydia screening by improving provider chlamydia screening by improving provider compliance with existing screening compliance with existing screening protocols.protocols.

The Proposed Study Provide cervical NAAT chlamydia Provide cervical NAAT chlamydia

screening to all women ages 20-25 screening to all women ages 20-25 undergoing pelvic exams in selected IBC undergoing pelvic exams in selected IBC Ob/gyn offices.Ob/gyn offices.

Collect data on DOB, race/ethnicity, zip Collect data on DOB, race/ethnicity, zip code, provider code, test result.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.

Successes

Initiated contact – got the issue somewhere Initiated contact – got the issue somewhere on the radar screen.on the radar screen.

Generated interest in supporting the study – Generated interest in supporting the study – CDC, Pfizer, Roche DiagnosticsCDC, Pfizer, Roche Diagnostics

Learned more about IBC administrative and Learned more about IBC administrative and logistical operations, especially data and logistical operations, especially data and laboratory organization.laboratory organization.

Stumbling Blocks

Lack of understanding of the diseaseLack of understanding of the disease Medical Director was unfamiliar with the Medical Director was unfamiliar with the

asymptomatic nature of CT, high prevalence rates, asymptomatic nature of CT, high prevalence rates, and sequelae.and sequelae.

Lack of concern about downstream costsLack of concern about downstream costs In spite of prior cost-effectiveness data, IBC not In spite of prior cost-effectiveness data, IBC not

concerned about paying for treatment of PID and concerned about paying for treatment of PID and other sequelae in the future.other sequelae in the future.

Little consequence of HEDIS measureLittle consequence of HEDIS measure Sense that purchasers are not concerned about Sense that purchasers are not concerned about

chlamydia screening.chlamydia screening.

Stumbling Blocks No connection acknowledged between No connection acknowledged between

knowing prevalence and changing knowing prevalence and changing physician behavior.physician behavior.

Contract laboratory not interested in Contract laboratory not interested in collaborating in the study – very interested collaborating in the study – very interested in charging high prices for testing.in charging high prices for testing.

Concern about liabilityConcern about liability Medical Director feared that patients Medical Director feared that patients

would be resistant to screening, and that would be resistant to screening, and that this liability would not be outweighed by this liability would not be outweighed by the benefitsthe benefits

Conclusions

Chlamydia screening is not important to the Chlamydia screening is not important to the plan – still not on the radar screen.plan – still not on the radar screen.

HEDIS measure is not enough of a HEDIS measure is not enough of a motivator – plan sees no consequences of a motivator – plan sees no consequences of a score of less than 20% on the HEDIS score of less than 20% on the HEDIS measure.measure.

Chlamydia is a “small ticket” item for the Chlamydia is a “small ticket” item for the plan – little motivation to make a change.plan – little motivation to make a change.

Next Steps

Region III exploring barriers to screening Region III exploring barriers to screening among commercial MCOs in the region.among commercial MCOs in the region.

Planning to conduct a chlamydia prevalence Planning to conduct a chlamydia prevalence study among private physician groups study among private physician groups rather than working through health plans.rather than working through health plans.

Hope to use data gathered to help plans Hope to use data gathered to help plans increase screening efforts and improve increase screening efforts and improve performance on HEDIS measure.performance on HEDIS measure.