HPV Collaborative Performance Improvement Project (PIP) LAURA CONNOLLY RN, MBA, MSN, DIRECTOR QUALITY MANAGEMENT, UNITEDHEALTHCARE SUSAN HOOD, RN, MSN, DIRECTOR QI, SUNFLOWER HEALTH PLAN ROBIN SIMMONS, RN, BS, SR. CLINICAL QUALITY AUDIT ANALYST, AMERIGROUP INC.
Agenda
CMS PIP Requirements
PIP Background
PIP Objectives
PIP Strategies to Improve Compliance with HPV Vaccination Goals
Barriers to Care
Responding to Parental Concerns
CMS Requirements for a Performance Improvement Project (PIP)
A fully acceptable PIP:
Is responsive to all identified issues;
Is measurable;
Identifies the source of the problem;
Addresses what modifications in processes/procedures that will occur;
Addresses immediate and ongoing staff training;
A timeline with milestones if the PIP extends over 30 days;
Background
August 2014- National Foundation for Infectious Diseases (NFID) Call to Action makes HPV vaccination a public health priority. The CDC and the President’s Cancer Panel have also identified improving HPV vaccination as a public health priority.
HPV vaccination prevents cancer
In the US, almost everyone will be infected with HPV at some point in their lives
HPV Vaccines are the most effective and safest way to protect against HPV-related cancers
Despite concrete scientific evidence, HPV vaccines are underused
Report shows Kansas has the lowest HPV vaccination rate
2015- PIP developed, approved, and implemented
Current State
HPV vaccination prevents cancer •
In the US, almost everyone will be infected with HPV at some point in their lives •
According to CDC, about 79 million Americans are currently infected with HPV.
•
About 14 million people become newly infected each year.
HPV Vaccines are the most effective and safest way to protect against HPVrelated cancers •
Protect against HPV types 16 and 18, which cause cancer
HPV vaccines are more than 98% effective in reducing the incidence of HPV 16- and HPV 18-related cervical pre-cancers
Despite concrete scientific evidence, HPV vaccines are underused •
Routine vaccination of females was only 38%
•
Routine vaccination of males was only 14% (2013)
Report shows Kansas has the lowest HPV vaccination rate
Current State- Concerns Top Five Reasons for Not Receiving HPV Vaccines* Female
Male
Not needed
27.0% 26.6%
Not recommended
15.9% 22.5%
Knowledge deficit
11.1% 19.1%
Safety concerns/Side effects
15.1% 6.4%
Not sexually active
10.3% 8.1%
HPV Vaccination Nationally Distribution
Centers for Disease Control and Prevention, July 31, 2015
HPV Vaccination Rates Across Kansas
HPV PIP Objectives
Collaborative efforts by three KanCare MCOs to increase compliance in Kansas Medicaid membership with HPV vaccination series
Increase compliance with Humanpapillomavirus (HPV) series of three vaccinations in female adolescents by their 13th birthday to reduce the risks associated with contracting HPV
HPV is associated with multiple types of cancers found in both females and males
Increasing vaccinations rates will directly impact the numbers of adolescents who will likely contract HPV or develop cancers associated with HPV
KanCare HPV PIP Details
KanCare MCO HEDIS rates for measurement year 2014, baseline for PIP performance
Amerigroup 14.58%
Sunflower 21.67%
UnitedHealthcare 17.03%
Goals for improvement in measurement year 2015
Amerigroup 17.36%
Sunflower 22.03%
UnitedHealthcare 17.36%
HPV PIP Objectives
2013 HEDIS data revealed opportunity for improvement for vaccination for HPV in 13 year old females for 367 commercial plans and 153 Medicaid Plans
Average performance on HEDIS measure for HPV was 12-19%
Maximum rate for commercial plans was 34%
Maximum rate for Medicaid plans was 52%
(Ng, et al., 2015)
HPV PIP Objectives
Routine HPV vaccination series is recommended for adolescents
Females 9-26 years of age, 11-12 years is target
Males 9-21 years of age, 11-12 years is target
Any vaccine can be used to finish the series if an adolescent has started the series and needs to complete
Interruption in the series does not require starting the series over
HPV PIP Strategies
Provider
High Touch: Medical Director to Physician
Provider Newsletter/Provider Website
Gaps in Care Report
Clinic Days
Parent
Mailings to members needing HPV vaccines
Community
Working with Health Departments throughout the state for clinic days
HPV Barriers
Missed opportunities when adolescent is seen in provider offices
Not educating and/or offering vaccine
Safety concerns (side effects, reactions, etc.)
Parental reluctance due to child is not currently sexually active
Lack of knowledge related to vaccine for adolescents, teens, young adults and parents/guardians
Cultural and language barriers that lead to lack of understanding or knowledge
Misunderstanding related to interruption in series of vaccination requiring starting over
HPV Barriers
Focus on female adolescents in HEDIS, likely changing in future to include male adolescents
Not completing series of three vaccinations
Completing the series after 13th birthday
