Presented by Ken Bence, M.H.A., M.B.A. Director of Public Health, Medica, at the 2013 National Chlamydia Coalition meeting

1. Perspectives on Performance in Health
Plans: Planning of Measures, Health Plan
Practice, and Possibilities for Increasing
Chlamydia Screening Rates
A Health Plan Case Study
Ken Bence, M.H.A., M.B.A.
Director of Public Health
Presentation to the National Chlamydia Coalition
February 20, 2013
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2. About Me
http://www.goldenvalleymn.gov/fire/firefighters/bence/index.php
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3. Minneapolis, MN
February 23, 2013
Accenture Tower
http://bit.ly/VbAbhl 3

4. Overview for Today
• Brief introduction to Medica
• Minnesota Medicaid Managed Care
• Why Chlamydia?
• Programs & Interventions
• Ideas to Adopt/Adapt
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5. Medica Health Plans
Started as a physician-owned plan in
1975
Part of Allina (integrated health system)
1994-2001
A full service insurer
 Commercial group, Medicare, Medicaid, TPA
Medica Service Area (MSA)
and Individual plans and services
 Open access, PPO, HMO, tiered and care
system networks
A regional plan + national reach
 96% of area physicians
 Nearly 27,000 regional physicians and
healthcare professionals, >615,000 nationally
 More than 240 regional hospitals, >5,000
nationally
UnitedHealth Group National Network Coverage
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6. Mission
Vision
We do much more than finance care and process claims
We encourage prevention, fitness and wellness
We encourage members to get needed tests and care
We work with providers to improve outcomes, safety and efficiency
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7. Medica Today
 2nd largest Minnesota health insurer
 Primary business is in MN, ND, SD and WI
 National coverage alliance with other insurers
 More than 1.6 million members
 Employer-based group coverage
 Leased networks and services
 Individual-Family
 Medicare
 Medicaid
 Health Management
 Nonprofit
 $3.8 billion annual premium adjusted revenue in 2011
 90% of premiums go to care
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8. Corporate Giving
• Mission is to fund community-based initiatives and programs that support the
needs of Medica’s customers and the greater community by improving their
health and removing barriers to health care services
• Grants awarded to 501(c)(3) or governmental organizations throughout Medica’s
service area
• Awarded over 600 grants totaling more than $12 million since 2003
• Annual funding priorities posted each March 1st
• 2012 Funding Priorities:
 Behavioral Health - Filling the Gaps
 Reducing Inappropriate Emergency Room Utilization, Hospital Admissions & Readmissions
 Primary Care and Preventive Health Services for People with Disabilities
 Early Childhood Health
 Organizational Core Mission Support
• www.medicafoundation.org
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9. State Public Programs
Medica is ranked 14th best Medicaid
health plan nationally by NCQA
#1 in Minnesota
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10. Minnesota’s Healthcare Landscape
• A system of NON-PROFIT providers & payers, BY LAW
• All licensed health plans MUST participate in state healthcare
programs, BY LAW
• All Medica providers MUST participate in all product lines, BY
CONTRACT
 Hospitals & Health Systems  Health Plans
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11. Minnesota’s Medicaid Managed Care Model
Medical Assistance (MA)
• Minnesota’s version of traditional Medicaid, based on income
• State/federal funding, administered by Department of Human Services
(DHS)
• Covers kids < 21, pregnant women
• May also cover qualifying adults with kids, disabled
MinnesotaCare
• For families and children above the Medicaid income limits, even if
they have access to insurance (“working poor”)
• State subsidized, sliding-scale premiums
Minnesota’s Medicaid Expansion
• Brings adults without kids into MA, federally funded 11

12. Collaboration Plans
• Mandated in statute since 1995
• All HMOs shall file a plan every five years with the Commissioner
of Health
• Describes the actions the plan intends to take to contribute to
achieving one or more high-priority public health goals
• Must be jointly developed with LPH and other community
organizations providing health services within the same service
area as the plan
• All HMOs shall file reports updating progress on their plan
• Current plan (2010-2014) was done collaboratively with all plans
together, through agreement with the Department of Health 12

13. So….
Why Medica’s interest in Chlamydia?
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14. New HEDIS Measure in 2001
Commercial Medicaid
80%
70%
60%
50%
40%
30%
20%
10%
0%
2001 2002 2003
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15. Environmental Factors
• Infections on the rise in Minnesota, especially urban/suburban
• Growing awareness of disparities
• Priority for Metro local public health
• Collaboration plans
• Emerging privacy considerations
• Urine test available
• Later, Expedited Partner Therapy (2008)
• Became one of the State’s quality metrics for prevention
Provider Factors
• Inconsistencies among providers, despite clear preventive
health guidelines
• MN Community Measurement
• Patients may be going elsewhere to avoid
insurance claims
• Discomfort taking sexual histories
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16. So….
What did we do?
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17. First, we studied the problem!
• Chart audits
• Literature review
• Physician consultations
• Department of Human Services study
Our Findings:
• The problem is multi-faceted
• A comprehensive solution is needed
• Our leverage points:
• Providers
• Enrollees/patients
• General
• Targeted
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18. So we made a plan….
Provider-directed Initiatives
Financial incentive for primary care providers,
added to existing program (PIP)
Tool kits for clinics
• Chlamydia screening & treatment guidelines
• Chlamydia statistics & coding recommendations
• Fact sheets, forms, wallet cards & posters
• Chlamydia care path(s)
• “Diagnosis and Treatment of Chlamydia in Pregnancy”
• Comparison of Chlamydia Testing Technologies
• Guide to Sexual History Taking
• Online Chlamydia Course (California STD/HIV Prevention Center)
with CMEs
• Journal articles
• MN Family Planning and STD Hotline information
Clinic-level data
Newsletter articles
Consultation
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19. Member-directed Initiatives
• Clinical case managers provided with scripting for appropriate
members
• Medica CallLink® 24/7 nurse line reminders for appropriate callers
• Referral resources provided to customer service representatives
• Information included in preventive health mailings
• Chlamydia screenings added to The Way to Better
HealthSM member incentive program – for males too!
• Targeted mailings to males & females,
including vouchers
• Newsletter articles – “It’s Your Health”
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20. So….
What happened?
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21. Medicaid Commercial
80%
70%
60%
50%
40%
30%
20%
10%
0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
HEDIS Year
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22. So….
What’s next?
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23. Healthcare Reform!
• More people insured
• First dollar preventive care
coverage
• Reproductive health care
debates
• Confusion
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24. And more of the same….
Working through partnerships
• A new PIP:
• Collaborative, 4 health plans working together
• Will work with clinics to support their efforts
• Developed a new provider tool kit
• Will support the MN Chlamydia Partnership to promote the State
strategy
• Total Cost of Care arrangements with key healthcare systems
• Aligned with State Health Care Home and other alternative payer
arrangements
• Promotes relationships with primary care
• Encourages provider organizations to innovate
• Primary Care Designation project in State Public Programs
• Enhanced community outreach
• “Triple Aim”
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25. Thank you!
Questions?
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