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Presentation to the National Chlamydia CoalitionFebruary 20, 2013

A Health Plan Case Study

Ken Bence, M.H.A., M.B.A.Director of Public Health

Perspectives on Performance in Health Plans: Planning of Measures, Health Plan Practice, and Possibilities for Increasing Chlamydia Screening Rates

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About Me

http://www.goldenvalleymn.gov/fire/firefighters/bence/index.php

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Minneapolis, MNFebruary 23, 2013Accenture Tower

http://bit.ly/VbAbhl

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Overview for Today

• Brief introduction to Medica

• Minnesota Medicaid Managed Care

• Why Chlamydia?

• Programs & Interventions

• Ideas to Adopt/Adapt

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Medica Health Plans

Started as a physician-owned plan in 1975

Part of Allina (integrated health system) 1994-2001

A full service insurer Commercial group, Medicare, Medicaid,

TPA and Individual plans and services Open access, PPO, HMO, tiered and care

system networks

A regional plan + national reach 96% of area physicians Nearly 27,000 regional physicians and

healthcare professionals, >615,000 nationally

More than 240 regional hospitals, >5,000 nationally

Started as a physician-owned plan in 1975

Part of Allina (integrated health system) 1994-2001

A full service insurer Commercial group, Medicare, Medicaid,

TPA and Individual plans and services Open access, PPO, HMO, tiered and care

system networks

A regional plan + national reach 96% of area physicians Nearly 27,000 regional physicians and

healthcare professionals, >615,000 nationally

More than 240 regional hospitals, >5,000 nationally

UnitedHealth Group National Network Coverage

Medica Service Area (MSA)

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Mission

Vision

We encourage prevention, fitness and wellness

We encourage members to get needed tests and care

We work with providers to improve outcomes, safety and efficiency

We do much more than finance care and process claims

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Medica Today

2nd largest Minnesota health insurer Primary business is in MN, ND, SD and WI National coverage alliance with other insurers

More than 1.6 million members Employer-based group coverage Leased networks and services Individual-Family Medicare Medicaid Health Management

Nonprofit $3.8 billion annual premium adjusted revenue in 2011 90% of premiums go to care

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Corporate Giving

• Mission is to fund community-based initiatives and programs that support the needs of Medica’s customers and the greater community by improving their health and removing barriers to health care services

• Grants awarded to 501(c)(3) or governmental organizations throughout Medica’s service area

• Awarded over 600 grants totaling more than $12 million since 2003• Annual funding priorities posted each March 1st

• 2012 Funding Priorities: Behavioral Health - Filling the Gaps Reducing Inappropriate Emergency Room Utilization, Hospital Admissions &

Readmissions Primary Care and Preventive Health Services for People with Disabilities Early Childhood Health Organizational Core Mission Support

• www.medicafoundation.org

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State Public Programs

Medica is ranked 14th best Medicaid health plan nationally by NCQA

#1 in Minnesota

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Hospitals & Health Systems

Minnesota’s Healthcare Landscape

•A system of NON-PROFIT providers & payers, BY LAW

•All licensed health plans MUST participate in state healthcare programs, BY LAW

•All Medica providers MUST participate in all product lines, BY CONTRACT Health Plans

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Minnesota’s Medicaid Managed Care Model

Medical Assistance (MA)• Minnesota’s version of traditional Medicaid, based on

income• State/federal funding, administered by Department of

Human Services (DHS)• Covers kids < 21, pregnant women• May also cover qualifying adults with kids, disabled

MinnesotaCare• For families and children above the Medicaid income limits,

even if they have access to insurance (“working poor”)• State subsidized, sliding-scale premiums

Minnesota’s Medicaid Expansion• Brings adults without kids into MA, federally funded

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Collaboration Plans

• Mandated in statute since 1995

• All HMOs shall file a plan every five years with the Commissioner of Health

• Describes the actions the plan intends to take to contribute to achieving one or more high-priority public health goals

• Must be jointly developed with LPH and other community organizations providing health services within the same service area as the plan

• All HMOs shall file reports updating progress on their plan

• Current plan (2010-2014) was done collaboratively with all plans together, through agreement with the Department of Health

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So….

Why Medica’s interest in Chlamydia?

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New HEDIS Measure in 2001

2001 2002 20030%

10%

20%

30%

40%

50%

60%

70%

80%Commercial Medicaid

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Environmental Factors• Infections on the rise in Minnesota, especially

urban/suburban• Growing awareness of disparities• Priority for Metro local public health• Collaboration plans• Emerging privacy considerations• Urine test available• Later, Expedited Partner Therapy (2008)• Became one of the State’s quality metrics for

preventionProvider Factors• Inconsistencies among providers, despite clear

preventive health guidelines• MN Community Measurement

• Patients may be going elsewhere to avoid insurance claims

• Discomfort taking sexual histories

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So….

What did we do?

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First, we studied the problem!• Chart audits• Literature review• Physician consultations• Department of Human Services study

•The problem is multi-faceted•A comprehensive solution is needed•Our leverage points:

• Providers• Enrollees/patients

• General• Targeted

Our Findings:

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So we made a plan….

Financial incentive for primary care providers, added to existing program (PIP)

Tool kits for clinics• Chlamydia screening & treatment guidelines• Chlamydia statistics & coding recommendations• Fact sheets, forms, wallet cards & posters• Chlamydia care path(s)• “Diagnosis and Treatment of Chlamydia in Pregnancy”• Comparison of Chlamydia Testing Technologies• Guide to Sexual History Taking• Online Chlamydia Course (California STD/HIV Prevention

Center) with CMEs• Journal articles• MN Family Planning and STD Hotline information

Clinic-level data

Newsletter articles

Consultation

Provider-directed Initiatives

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Member-directed Initiatives

• Clinical case managers provided with scripting for appropriate members

• Medica CallLink® 24/7 nurse line reminders for appropriate callers

• Referral resources provided to customer service representatives

• Information included in preventive health mailings

• Chlamydia screenings added to The Way to Better HealthSM member incentive program – for males too!

• Targeted mailings to males & females, including vouchers

• Newsletter articles – “It’s Your Health”

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So….

What happened?

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120%

10%

20%

30%

40%

50%

60%

70%

80%Medicaid Commercial

HEDIS Year

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So….

What’s next?

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Healthcare Reform!

• More people insured• First dollar preventive care coverage

• Reproductive health care debates

• Confusion

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And more of the same….Working through partnerships

• A new PIP:

• Collaborative, 4 health plans working together

• Will work with clinics to support their efforts• Developed a new provider tool kit

• Will support the MN Chlamydia Partnership to promote the State strategy

• Total Cost of Care arrangements with key healthcare systems

• Aligned with State Health Care Home and other alternative payer arrangements

• Promotes relationships with primary care

• Encourages provider organizations to innovate

• Primary Care Designation project in State Public Programs

• Enhanced community outreach

• “Triple Aim”

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Thank you!

Questions?