increasing screening in the private sector task force gale r burstein, md, mph, faap medical...
TRANSCRIPT
Increasing Screening in the Private Sector Task Force
Gale R Burstein, MD, MPH, FAAP Medical Director Epidemiology and Surveillance and STD & TB Control Erie County Department of HealthBuffalo, New York
November 1, 2006
Adolescent STI Services: Challenges and Opportunities
Health systems level
Provider level
Patient (adolescent) level
Adolescent STI Services: Challenges and Opportunities
Systems Level
Systems Level: Opportunities
New opportunities for routine non-invasive STI testing Urine nucleic acid amplification tests (NAATs) for STIs
New Pap smear guidelines – 1st Pap at 3 years after start sex or at 21 years old
Chlamydia testing sexually active 16-25 year old females is HEDIS measure
Systems Level: Opportunities
All 50 states and D.C. have laws allowing minors right to consent for STI testing and treatment30 states include HIV testing and treatment in
STI services to which minors may consent
Federal funding for STI testing and care
A minor (person <18 yrs), may be counseled, tested and treated for STIs without a parent or guardian's consent, as long as the minor understands the risks and benefits of the proposed and alternative treatments.
“Information about STIs cannot be released to parents or guardians without the patient’s permission.”
New York State Minors Reproductive Rights Law
Systems Level: Challenges NYS Insurance Law Section 3234
Mandates that health insurance companies provide to their members/subscribers an explanation of benefits (EOB) statement following a filed claim under any policy providing hospital or medical expense benefits (Circular Letter No. 7, March 24, 2005).
EOB must contain information about the date, cost and scope of health care services received. no exception relating to the age of the member
receiving the service or the nature of that service.
Systems Level: Challenges$$$$$$$$
Adolescent age group most likely to be uninsured
Copayments may be barrier for youth receiving care
How to bill for “confidential” health care services? Explanation of Benefits may result in disclosure to parent
Difficult to bill for sexual health services More time in visit not reimbursed Cannot bill for “first” pelvic exam
Systems Level: ChallengesAccess/Availability
Health plans may not offer urine STI NAAT tests
Many providers do not offer STI services
Limited time available for health care visit
Limited provider office hours
Adolescent access to transportation
Adolescent STI Services: Challenges and Opportunities
Provider Level
Provider Level: Knowledge
Not aware of non-invasive STI test options new urine chlamydia NAATs New Pap test guidelines
Unfamiliar with minors’ rights to consent for STI care
Lack of STI clinical training
Unclear how to bill for confidential STI services
Provider Level: Skill
Many not skilled or comfortable offering confidential sexual health services to adolescentsPerforming an “atraumatic parentectomy”Discussing sexual health, including sexual
activity information
Provider Level: Beliefs
Assume that chlamydia is not a health problem in their adolescent patient population
Low priority and lack of time
Perceive inadequate reimbursement and financial disincentives for providing sexual health services
Adolescent STI Services: Challenges and Opportunities
Adolescent Patient Level
Patient Level: Knowledge
Teens unaware of need for preventive health care services
Lack of knowledge regarding STIs Most have no symptomsUsually need a test to identify infection
Patient Level: Beliefs
Falsely perceive low STI-riskstigma
Perceive primary care provider does not want to address sexual health needs
Health care is a low priority
Believe cannot receive confidential services
Is this hopeless????
Providing Confidential Care for Adolescent Healthcare in Primary Care Settings
A Region II Infertility Prevention Project Demonstration Project
Partnership with the Foundation for Healthy Living
The Foundation For Health Living (FHL), Albany, NY
Non-profit, 501(c)3 health services and research foundation
Mission to increase and disseminate knowledge about health care and improve health of NYS residents.
Affiliated with HealthNow New York, Inc. Blue Cross Blue Shield subsidiary A leading NYS health plan Serves members from over 53 counties in Upstate NY
Providing Confidentiality for Adolescent Health Care: A Demonstration Project
1) Develop a consensus statement on adolescent confidentiality in health care in private practice settings
2) Develop a set of recommendations for the NYSDOH and NYS Insurance Department to address gaps in adolescent confidentiality in the provision of STI-related care for commercially insured clients in private practice settings.
Providing Confidentiality for Adolescent Health CareAdvisory Work Group
Comprised of adolescent health care stakeholders NYSDOH New York State Insurance Department health plans prominent pediatricians adolescent health physicians
PCAHC Demonstration Project Objectives
To better understand the need for confidential adolescent health care
Identify barriers to confidential adolescent health care
Review the current legal and regulatory state as it pertains to confidential adolescent health care
Propose a series of recommendations for short and long term solutions to remove barriers
Collate and disseminate findings from proceedings.
Wherever possible, facilitate translation of outcomes and products for use throughout the nation.
PCAHC Demonstration Project Activities
Create an advisory work group of medical, health and policy experts Identify national experts who will help inform workgroup activities Convene 2 PCAHC meetings Stakeholders will convene meetings with local stakeholders to vet
recommendations Review the NYS Reproductive Minor’s Right’s Law Review reproductive health recommendations from professional
medical societies, adolescent health providers and advocacy organizations
Consider the unique barriers related to the provision of confidential reproductive health services for commercially insured adolescents
Assess model provider-patient confidentiality tools across the country Consider educational interventions and materials tailored to health care
providers, parents and adolescents
PCAHC Demonstration Project Outcomes
Develop consensus statement on adolescent confidentiality in health care
Provide recommendations to NYSDOH and Insurance Department to address gaps in adolescent confidentiality
Publish and disseminate findings, lessons learned and recommendations, emphasizing both local and national implications.
Conduct assessment among identified health plans to determine if they made or plan to make any changes related to the provision of confidential STD-related care as a result of demonstration project recommendations.