Effort to Initiate a Chlamydia Prevalence Study within a Managed Care Organization in Philadelphia

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.
• 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.

3
Objectives

• 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.
• Explore potential next steps.

4
The Players

• 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.
• 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.
• Meetings/conference calls held with OB/Gyn and
  overall Medical Directors to discuss development
  of study.
• Initial protocol drafted by CDC.
• 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.
• 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.
• Collect data on DOB, race/ethnicity, zip code,
  provider code, test result.
• Determine prevalence by provider.
• Study to run for six months.

8
Successes

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

9
Stumbling Blocks

• Lack of understanding of the disease
• Medical Director was unfamiliar with the
  asymptomatic nature of CT, high prevalence rates,
  and sequelae.
• 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.
• Little consequence of HEDIS measure
• Sense that purchasers are not concerned about
  chlamydia screening.

10
Stumbling Blocks

• 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.
• Concern about liability
• 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.
• 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.

12
Next Steps

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