Anthem Blue Cross
Adolescent Health Initiatives Harvinder Sareen, PhD, MPH Director, Clinical Programs
August 28, 2008
Acknowledgement
Special thanks to Tumaini Coker, Mark Schuster, Lakshmi Dhanvanthari, Debby Ducker, Mary Beth East, Sallie Negin, Doris Wells, Joe Ruiz, and Elizabeth Mayer Armstrong for assistance in developing this presentation.
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Presentation Overview
California’s Uninsured Adolescents/Young Adults
Utilization of Well-Adolescent Care
Anthem Blue Cross Initiatives
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California’s Uninsured CA Uninsured Rate by Age Group (2000-2005) 39%
40 35
32%
31% 30 25
22% 19%
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17% 14%
15 10 5
12 to 17
0 Under 18
18-20
21-24
25-34
2000
35-44
45-54
55-64
2005 Source: California HealthCare Foundation
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Well-Adolescent Care
Guidelines Multiple guidelines AAP Recommendations for Pediatric Preventive Care AAFP Age Charts for Periodic Health Examination AMA GAPS Bright Futures US Preventive Services Task Force
General recommendations Health promotion and disease prevention Annual visits Immunizations, guidance and counseling, behavioral screening, lab screening
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Well-Adolescent Care
Utilization Visits • By adolescent report: 60%-82% had a visit in the past 12 months • By parent report: 66%-70% had a visit in the past 12 months • HEDIS data: 34%-44% had a visit in the past 12 months
Counseling/Care
At least 1/2 of adolescents report that they did not receive recommended health counseling • 57% of girls and 74% of boys did not discuss STI, HIV, or pregnancy prevention • 82% did not receive counseling on other risky behaviors • 50% did not receive counseling on weight, diet, and exercise
US adolescents receive 35% of indicated well-adolescent care based on abstraction of medical records 8 adolescent health indicators (e.g. annual visit, growth monitoring, blood pressure screening) 6
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Well-Adolescent Care
Barriers Direct
Focus groups and interviews of 1,948 15-17 year olds in small towns in a Minnesota county
Lack of confidentiality in a small-town clinic
Indirect
Young Adult Health Care Survey to 4,600 commercially and publicly insured adolescents enrolled in MCOs
Adolescents who don’t have a chance to meet privately with their doctors are less likely to have a well visit
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Well-Adolescent Care
Barriers
Adolescence
Lack of knowledge of Preventive Health Services • About preventive care • About where to receive care
Access issues
Concerns about confidentiality and privacy
Beliefs about physician effectiveness
Fear of medical procedures
• Transportation, time, cost
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Well-Adolescent Care Strategies to Increase Utilization
Parents/family and adolescent education
Outreach to adolescents
Patient reminders
Organizational/practice changes • Scheduling and availability • Non-office formats for delivery of services • Non-physician staff to deliver services
Patient financial incentives
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Programs Connecticut Medicaid Managed Care Council Adolescent Care Projects 4 participating MCOs from 2003-2004 Intervention included: • Teen outreach • Youth advisory group • Monthly evening reminder calls
Increased well visit rates from 57% to 63%
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Health Partners Study Intervention group (2,186 Medicaid children ages 10-18 in Minnesota) • Parent mailing about incentive program • Birthday mailing reminder for a well visit • $30 gift card when visit complete and verified
Comparison group (1,723) Intervention group had a greater change in PHS use, 2002-2003 (10% increase vs. 5% increase, p 40,000 applications
Jan 2007 - Apr 2008
> 1,000,000 applications
Ages 19 - 29
46%
Ages 0 - 18
17%
TONIK CT, CO, GA, NH, NV • Similar trend
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Anthem Blue Cross Lumenos Consumer-driven health plans HSA, HRA and HIA+
Traditional Health Coverage
• Health Savings Account • Employer/employee or both contribute • Unused funds roll over • Dollars owned by employee
• Health Reimbursement Arrangement • Employer contributes • Roll over provisions • Similar to the HSA
Preventive Care Coverage Personalized Services and Tools Health Rewards – extra health care dollars
• Health Incentive Account plus • WellPoint allocates dollars 18
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NuestroBien
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Anthem Blue Cross State Sponsored Business Health Services Adolescent Programs Well-Adolescent Visits
•
Birthday Reminders
High Risk OB Program
• •
Teen Pregnancy Teen Smoking
24/7 Nurse Line
• • •
Teenline/Live Person Audio Libraries English/Spanish
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Anthem Blue Cross Statewide Adolescent IQIP
Anthem Blue Cross State Sponsored Business •
Participation in California Department of Health Services Initiative •
Community Resource Centers
“Improving Adolescent Health Care in Medi-Cal Managed Care”
Goals •
Increasing the rate of annual adolescent well-care visits
•
Improving adolescent health care at the point of service.
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Anthem Blue Cross Statewide Adolescent IQIP Member Interventions/Measures •
Well-visit reminders
•
Follow-up adolescent surveys
Physician Interventions •
Site visits by CRC staff
•
Fax blasts on well-adolescent care
•
Adolescent care toolkit
•
Physician Training •
Adolescent CME Program – Anthem
•
Train the Trainer Program – CA DHS
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Adolescent IQIP Outcomes Follow-up adolescent survey •
Comparison by age revealed that adolescents participating in the study generally received more counseling and screening in the 15 to 18 age groups compared with the 11 to 14 age groups.
•
Analyses of the study revealed that statewide, 56% of the recommended screening and counseling was being performed.
•
Opportunities for improvement existed.
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State Sponsored HEDIS CA AWC Rates
• Healthy Families (HMO) • 2005: 41% • 2006: 37% • 2007: 44%
• MediCal • 2004: 33% • 2005: 36% • 2006: 36% • 2007: 40%
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Anthem Blue Cross/RAND Adolescent Access and Utilization Study
Purpose • To examine the views of adolescents and their parents on the use of well-adolescent visits. • To examine factors that may motivate adolescents to or prevent them from visiting their provider for well care.
Methods • 8 adolescent and 2 parent focus groups • 13-15 and 16-17 year-old Anthem Blue Cross MediCal enrollees • English and Spanish language
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Adolescent Access and Utilization Study
Determine how WellPoint can encourage Medicaid-insured adolescents to attend annual well visits
Incentives
Physician and practice characteristics
Delivery of health information to adolescents
Ensuring confidentially Influence of parents and peers
Significance of findings to other health plans
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Adolescent Access and Utilization Study Team Anthem Blue Cross
RAND
Harvinder Sareen (PI) Lakshmi Dhanvanthari
Mark Schuster (PI)
Sallie Negin
Rosa-Elena Garcia
Vanessa Marlow Elizabeth Mayer-Armstrong
David Kennedy
Tumaini Coker
Beverly Weidmer
Yvonne Valdez Patricia Browne
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Next Steps
Unique Population
Unique Needs
Innovative Strategies
Share Best Practices
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Thank you.
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