Anthem Blue Cross Adolescent Health Initiatives

Anthem Blue Cross Adolescent Health Initiatives Harvinder Sareen, PhD, MPH Director, Clinical Programs August 28, 2008 Acknowledgement Special tha...
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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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