Women’s health issues included in managed care report card

HEDIS 2000 includes chlamydia screening, menopause counseling

How do managed health care plans rate when it comes to provision of women’s services? A clearer picture will become evident this year as data are collected on two important areas of care: chlamydia screening and management of menopause.

The National Committee for Quality Assurance (NCQA) in Washing ton, DC, a nationwide organization charged with measuring and reporting on managed care quality, has included the two measures in its Health Plan Employer Data and Information Set (HEDIS) 2000.

Why should providers be concerned about NCQA and HEDIS? Org anizations such as NCQA are grading managed care plans on many aspects of care and making the results public, as evidenced in NCQA’s annual "State of Managed Care Quality" report and its Quality Com pass database. Many employers and consultants use the database, which contains performance data from hundreds of health plans, as a decision support tool to help select or negotiate care with their health plan partners. Health plans, in turn, evaluate providers on their ability to demonstrate acceptable levels of care on measures monitored through HEDIS.

The two women’s health issues joined two other items, controlling high blood pressure and appropriate medications for people with asthma, as additions to HEDIS 2000, according to Brian Schilling, NCQA spokesman. Information from the four new measures will not be reported until 2001, he says. "You won’t see any data in 2000 at all because the first year is sort of a run-in period where we make sure that the measures work."

Why chlamydia screening

The chlamydia screening measure assesses the percentage of sexually active women ages 15 to 25 who are screened for chlamydia. Chlamydia is now the nation’s most common sexually transmitted disease (STD), affecting about 3 million people annually, most of whom show no symptoms, according to NCQA. Consequences of the disease can include infertility and ectopic pregnancy. Fortunately, cure rates approach 97%, and treatment costs average under $10, NCQA reports.

Chlamydia screening is a simple yet powerful step. Researchers at Group Health Cooperative, a Seattle-based HMO, documented a 56% reduction in the incidence of pelvic inflammatory disease in high-risk women who were screened and treated for chlamydia.1

Public health officials say the new measure will be significant in focusing managed care providers and purchasers on the importance of screening and treating a disease that ordinarily is rarely on the radar screen for private provid ers, notes Judith Wasserheit, MD, MPH, director of the Division of STD Prevention in the National Center for HIV, STD, and TB Prevention at the Atlanta-based Centers for Disease Control and Prevention.

"We hope that since what is measured is what gets done, this measure will focus managed care providers a lot more on chlamydia in particular and, through that, on STDs and, more broadly, their impact on women," she states.

It is important to include managed care in prevention efforts against such STDs, says Thomas Eng, MD, president of the Institute for Interactive Health Communications in Washington, DC. Eng served as co-editor of The Hidden Epidemic: Confronting Sexually Transmitted Diseases, a 1996 Institute of Medicine report that called for the inclusion of STD-related performance measures in HEDIS to improve quality-assurance monitoring of STDs. Because plans will be evaluated on their performance in screening for chlamydia, they now have a direct interest in screening the targeted population, he notes.

Because chlamydia screening traditionally has been the expertise of public health personnel, health departments that also have such expertise should contact their local managed care plans to explore how they can work together to achieve HEDIS goals, says Eng. He chaired a two-day workshop that examined barriers impeding managed care organizations from providing comprehensive public health services and collaborating with health agencies.2

"I think to be serious about this, you need both direct clinical patient efforts, which the managed care plans would do, and also population-based outreach efforts, which most public health people are the best at doing," observes Eng. "I think that the two obviously need to talk to each other and try to think about how they can cooperatively intervene on both the community level and the individual patient level."

Counsel on menopause

The management of menopause measure, which is collected through patient surveys, is designed to capture information about the quality of menopause counseling women receive from their providers. The measure, based on a survey of a sample of women between ages 45 and 55, will examine the following three areas:

content: to examine whether the patient received counseling and was presented with a variety of treatment options;

personalization: to determine the extent to which the patient received "personalized" counseling that included not only her medical history, but also her values and concerns;

quality: to assess the patient’s overall satisfaction with the counseling and to determine whether the counseling was incorporated in her treatment or lifestyle.

Physician counseling and recommendations are likely to figure strongly in women’s decisions to begin hormone replacement therapy. Yet, just more than one-third of women ages 50 and older had physician counseling on this issue in the past year, according to a report issued by the Common wealth Fund.3 Women with low incomes or less than a college education were the least likely to report physician counseling on hormone therapy options, survey results showed.

The Women’s Health Measurement Advisory Panel of NCQA strongly recommended the menopause counseling measurement in HEDIS 2000, says David Archer, MD, a panel member and professor of obstetrics and gynecology and director of the Clinical Research Center at the Eastern Virginia Medical School in Norfolk. Women should have appropriate counseling and preventive health screening in their 40s and as they experience the menopausal transition, he notes.

"It is important to counsel all postmenopausal women on lifestyle and behavioral modification, along with performing an assessment of their risk factors for cardiovascular, osteoporotic, and neoplastic diseases," he says. "This assessment requires annual updating because of new medical information becoming available."

The amount of time required for the counseling session varies, says Archer. That flexibility must take into consideration the need for physician/ patient interaction to address all the patient’s concerns, as well as the time constraints of managed health care, he says.

"We don’t offer specific guidelines saying, This is exactly how the consultation must be performed, and these are the things you need to cover,’" Schilling of NCQA concurs. "We give the health plans and providers latitude in determining how they are going to track, promote, and execute any given intervention, whether it is counseling for menopause, chlamydia, or controlling high blood pressure."

References

1. Scholes D, Stergachis A, Heidrich F, et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334:1,362-1,366.

2. Eng TR. Prevention of sexually transmitted diseases: A model for overcoming barriers between managed care and public health. The IOM Workshop on the Role of Health Plans in STD Prevention. Am J Prev Med 1999;16:60-69.

3. Collins KS, Schoen C, Joseph S, et al. Health concerns across a women’s lifespan. The Commonwealth Fund 1998 Survey of Women’s Health. New York City; May 1999.

For more on the National Committee for Quality Assurance and HEDIS 2000, contact:

National Committee for Quality Assurance, 2000 L St. N.W., Suite 500, Washington, DC 20036. Telephone: (202) 955-3500. Web: www.ncqa.org.