MetroPlus Health Plan

1
MetroPlus Health Plan Take Care New York
Project Use of Different Care Models to Improve
Colorectal Screening Rates in a Female Medicaid
Population
2
Background of MetroPlus Health Plan

• 310,000 Medicaid managed care plan in NYC (all
  boroughs except
• Staten Island)
• Wholly owned subsidiary of NYC Health and
  Hospital Corporation (HHC)
• Approximately 50 of membership are in HHC
  facilities and 50 of
• membership are with community based providers
• Have performed above statewide average in the
  areas of breast and
• cervical cancer screening however have not
  allocated resources to
• promote colorectal cancer screening in the past.

3
Current Performance on Cancer Screening

• Amongst women between 50-64 continuously enrolled
  in MetroPlus for at least
• 12 months (n2,269), the screening rates were
• Colorectal cancer screening (any test) 53
• By type of screening used
• Colonoscopy within 10 years 36
• Home FOBT within 12 months 34
• Sigmoidoscopy within 5 years 2
• Barium enema within 5 years 1
• Breast cancer screening (mammogram within 2
  years) 84
• Cervical cancer screening (Pap test within 3
  years) 66

4
Take Care New York Project Goals

• Test efficacy of various care management models
  to improve colon cancer
• screening rates amongst women enrolled in
  MetroPlus and between the
• ages of 50 and 64.
• The following support is being offered to
  providers and members to identify
• optimal care management processes
• Provider education only All network providers
  will be mailed given
• a practice specific rate and a list of women
  overdue for a colonoscopy,
• as well as NYC DOHMH educational materials.
• Prevention Care Management (PCM) MetroPlus
  staff will provide
• telephonic support to women in need of
  colonoscopy from the point of
• contemplation of colon cancer screening to
  actual test completion.
• Patient Navigator (PN) HHC staff will provide
  both telephonic and
• face to face support from the point of
  contemplation of colon cancer
• screening to the actual test completion.
• PCM/PN Through a coordinated effort, members
  will receive support
• from both MetroPlus and HHC staff to the
  point of contemplation of colon
• cancer screening to actual test completion.

5
MetroPlus Study Groups
Study Group as Defined by CDN N200
Not in CDN Population
PCP Intervention PCM Intervention
PCP Intervention PCM/PN Intervention
PCP Intervention PN Intervention
PCP Intervention Only
HHC Facilities without a PN
HHC Facilities with a PN
HHC Facilities with a PN
Community Based PCPs
6
Timeline of Milestone Activities

• Member mailing to all MetroPlus members between
  the ages of 50-64
• who did not receive a colonoscopy Completed
  March 2008
• Pilot of PCM Model on 10 MetroPlus members June
  2008
• Provider Mailing to all network providers June
  2008
• Implementation of PCM and PN Model June 2008
  through
• September 2009
• 5. Final Analysis and Report Generation
  December 2009

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Measuring the Success of the Intervention

• The success and sustainability of the project
  will be measured using both
• process and outcome variables derived from
  claims, supplemental
• databases, and medical records. They will
  include at a minimum
• Number of interventions accomplished
• Number of calls made to the PCM and PN
  intervention groups
• Number of members requesting educational
  materials
• Number of members overdue for cancer screenings
• Number of members who did not keep scheduled
  appointments with their PCP
• Number of members who received a referral to the
  GI for a conoloscopy
• Rate of colon cancer screenings