Improving Women s Health in South Carolina Best Chance Network and WISEWOMAN. Dr. Trenessa K. Jones Best Chance Network Program Director

Transcription

1 Improving Women s Health in South Carolina Best Chance Network and WISEWOMAN Dr. Trenessa K. Jones Best Chance Network Program Director

2 Presentation Objectives Overview the History and Need for the Best Chance Network(BCN) and WISEWOMAN (WW) programs in South Carolina BCN program components, eligibility, and upcoming changes Benefits of using a physician champion as a successful strategy to increase breast and cervical cancer screenings

3 Presentation Objectives Implementing evidenced based initiatives for breast and cervical cancer screenings, cardiovascular risks Discussion of barriers to screenings. Advantages of implementing population health at the provider level Increase knowledge of breast and cervical cancer incidence and mortality rate data in South Carolina. County level eligible data-estimates

4 Best Chance Network History & Need National Breast and Cervical Early Detection Program NBCCEDP Low income, un-insured, underinsured women Breast and cervical cancer screening and diagnostic services South Carolina DHEC initially applied for this grant funding in 1991-Best Chance Network

5 Best Chance Network Services Breast cancer yearly services include: Mammograms (to include 3D mammography) Clinical breast exams Pap Tests Pelvic Examinations Human papillomavirus (HPV) tests Diagnostic testing, if necessary Referrals to treatment

6 Best Chance Network Services Cervical Cancer Screening Health history Co-testing with Pap test and high risk HPV panel HPV genotyping 16 & 18 Counseling visit for all high grade abnormal pap tests and colposcopy results LSIL pap results / CIN 1 LEEP or conization procedure, as indicated Referral to screening, treatment and patient navigation services

7 Best Chance Network Need Then.. When program began South Carolina was 3 rd in the Country in cervical cancer incidence Now South Carolina is currently 14 th in the Country in cervical cancer incidence

8 Best Chance Network Need However. Still approximately half of all cervical cancers in South Carolina are diagnosed late stage

9 Current Best Chance Network Eligibility Requirements Women must: Be a SC resident Be between the ages of 30 and 64 Have a household income at or below 200% of the Federal Poverty Limit Have insurance with a deductible of $1K or higher Have insurance that does not cover screenings and diagnostics at 100% Have insurance that covers hospitalization only

10 Upcoming Eligibility Changes Effective June 30, 2017: Cervical cancer screening age range will be changed to cover women between the ages of 21 and 64 Women must have a household income that is at or below 250% of the Federal Poverty Limit

11 WISEWOMAN History Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) National program authorized by Congress in 1993 Extends services to women enrolled in National Breast and Cervical Cancer Early Detection Program ( Best Chance Network in South Carolina) Screenings for cardiovascular disease and diabetes Referrals for medical evaluation as needed Health coaching and lifestyle programs Referrals to community resources that support healthy lifestyles

12 WISEWOMAN History Funded by Centers for Disease Control and Prevention Division of Heart Disease and Stroke Prevention July 1, 2008 June 30, 2013: South Carolina s first WISEWOMAN cooperative agreement July 1, 2013 June 30, 2018: South Carolina s current WISEWOMAN cooperative agreement Priority Group Women aged years old Low-income, under-insured or uninsured women with chronic disease risk factors Services to BCN women provides the opportunity to provide other cardiovascular services to women; particularly since heart disease is the leading cause of death for women in the United States

13 WISEWOMAN Need Diabetes in SC

14 WISEWOMAN Need Hypertension in South Carolina

15 Services covered include: Heart disease, stroke, and diabetes risk factor screening BP Weight/BMI/waist &hip circumference Lipid panel, HbA1c, glucose Health behavior assessment Referral and follow-up Counseling and links to community programs for nutrition, physical activity, and tobacco cessation resources

16 WISEWOMAN Services also provide health coaching, nutrition support, participation in diabetes prevention programs and weight loss programs such as Take Off Pounds Sensibly (TOPS), Weight Watchers, or other.

17 What is it worth to be a WW provider? REIMBURSEMENT (100% Medicare rate) FOR CLINICAL & HEALTH COACHING SERVICES Sample Scenarios Screening (clinical exam, patient health history & risk reduction counseling) Re-visit for counselin g for abnormal screening values Health coaching (1) individual 30- minute $45 + (2) 15-minute phone $20 + (3) online data $5 Total reimbursemen t per individual woman served Total reimbursemen t for 100 women served Total reimburseme nt for 200 women served SCENARIO #1 SCENARIO #2 SCENARIO #3 $ $47 $4,700 $9,400 $47 $ $ $11,615 $23,230 $47 -- $100 $147 $14,700 $29,400 SCENARIO #4 $47 $69.15 $100 $ $21,615 $43,230 Based on the SCWW Fee Schedule for June 30, 2016 through June 29, 2017

18 Common Factors Between Cancer & Cardiovascular Chronic Diseases Obesity is associated with increased risks of the following types of cancers and possibly others: Esophagus Pancreas Colon and rectum Breast (after menopause) Endometrium (lining of the uterus) Kidney Thyroid Gallbladder

19 Common Factors Between Cancer & Cardiovascular Chronic Diseases Heart disease associated with increased risk of type 2 diabetes; diabetes can raise risk of various cancers Research suggests that these diseases may relate to one another in multiple ways Nutrition and lifestyle strategies sued to prevent and manage these diseases overlap considerably Type 2 diabetes has been associated with colon, postmenopausal breast and pancreatic, liver, endometrial, bladder and non- Hodgkin's lymphoma. Adult survivors of childhood cancer may face an increased risk of type 2 diabetes and metabolic syndrome Heart disease maybe a cause for death for those who have some of the most common cancers.

20 Benefits of Offering BCN & WISEWOMAN Services Allows providers to: Provide comprehensive services to women Reduce barriers to screening Ensure health equity and culturally appropriate services Identify health disparities and implement programming specific to South Carolina

21 Benefits of these programs Provides payment to providers for screening and diagnostic services Use of population-based approaches to improve systems that increase high-quality breast and cervical cancer screening Expanded focus which supports planning and implementing activities to increase breast and cervical cancer screening rates among all women of appropriate screening age. This includes women who have Health insurance, especially the newly insured. Publicly funded insurance, such as Medicare or Medicaid. Access to Indian Health Service or tribal health clinics. Coverage through other programs or services.

22 What s at Stake Without intervention: Higher mortality rates for breast and cervical cancers in South Carolina Higher mortality rates due to cardiovascular disease Higher Incidence rates for both cancer and cardiovascular diseases Increased late stage diagnosis of cancers With intervention: Ability to treat some preventable cancers All people having the ability to have better health outcomes

23 PRIMARY GOAL? Joining Forces to OPTIMALLY INCREASE High Quality Screening & Rescreening Rates for Breast & Cervical Cancer & Cardiovascular Risk in South Carolina!!!!!!

24 HOW? By Translating the CDC s BIG 4 evidence based interventions for SCDHEC BCN & WW Programs INTO SMART PRACTICE Setting Practice Based Population Health Screening & Rescreening Goals Saves lives and Pays the bills Specific Know your baseline rates for screening & rescreening (X # of total # women in practice that need screening/rescreening); Measurable (Use that baseline # to set a quantifiable, trackable goal); Achievable (Ensure you have the capacity to attain your goal); Realistic (Make sure this number is genuine and that you have appropriate tracking mechanisms in place); Time-bound (Start with year s end in mind. Determine how many women you can reasonably screen by July 30, 2017 based on the # of women in your practice who need to be screened & rescreened. Track in real time.

25 HOW? 1. Client Reminder Systems Annual Screening & Rescreening Reminders for CBE, Pelvic Exam, Mammogram Example: postcards, letters, telephone call, appointment cards, EHR/EMR Automated Alert Calls. Public Service Announcement: BCN reimburses for these 3 procedures!

26 HOW? 2. Provider Reminder Systems Implementing a practicebased population health system: Know who needs what cancer & cardiovascular risk screening and rescreening Create an internal screening/rescreening registry Review screening needs during morning huddle Utilize EHR/EMR alerts Adopt standing orders or standard operating procedures.

27 HOW? SCDHEC BCN/WW Provider Assessment & Feedback includes, but is not limited to: Annual Provider Performance Indicator Report On-site Provider Audits Provider Feedback Questionnaire 3. Provider Assessment & Feedback Data: know, monitor, track & use it to inform decision making & set and achieve goals Use available data sources: Practice-level data SCDHEC BCN/WW Med-IT data SC Cancer Registry incidence & mortality data County-level uninsured estimates Incorporate evaluation & continuous quality improvement TIP:.IF You NEED Help figuring out how to utilize data, ask me!

28 HOW? 4. Reduce Structural Barriers Alternate or multiple locations Extended hours Flex or Block Days Increase cultural competency through training: CLAS & training offered via * Provide bilingual assistance for non-english speaking patients Understanding health disparities impact: Understanding circumstances that lead to health disparities Cultural, religious, economic, provider perceptions, social determinants of health. *Action Tip: Ask me for more info about this training.it also meets Associated HRSA & PCMH Standards!

29 Importance of Approach With the onset of more chronic diseases there is a need to redesign existing models of care delivery. Health reform is shifting from fee-for-service payment models to value-driven payment structures based on improving outcomes and enhancing the patient experience and reducing costs. Redesigning how cancer screening services are coordinated and delivered to ensure that benefits are to the health care practices to include effective delivery team. Effectiveness of Care and access/availability of care are part of Healthcare Effectiveness Data and Information Set (HEDIS) eight domains of care. Breast Cancer screening is a key HEDIS measure.

30 Population Health Population-level approaches are necessary to achieve significant improvement in practice Cannot improve care one patient at a time must make improvements for populations Must improve care for patients who seek care but also for whole populations (including those who are not actively seeking care) Essentials for population health management: Care team Health Information Technology (EMR, PM system) Care Processes (Outreach, Standing Orders) Care coordination systems/processes EMRs facilitate the management of data for patient populations

31 South Carolina Lung & Bronchus Female Breast Incidence Prostate Colorectal Melanoma Bladder Non-Hodgkin Lymphoma Kidney Pancreas Oral Cavity Mortality Lung & Bronchus Colorectal Female Breast Pancreas Prostate Leukemia Liver Non-Hodgkin Lymphoma Esophagus Brain TOP 10 SITES: INCIDENCE & Mortality FOR South Carolina

32 Top 10 Cancers in SC by Case Count by Sex, Cancer deaths for females ranked by count, Rank Rate Count All Cancer Sites ,944 1 Lung & Bronchus ,772 2 Female Breast ,375 3 Colon & Rectum ,966 4 Pancreas 9.6 1,466 5 Ovary 7.2 1,079 6 Leukemia Uterus/Corpus/NOS Non-Hodgkin Lymphoma Myeloma Liver & Intrahepatic Bile Duct Cancer deaths for males ranked by count, Rank Rate Count All Cancer Sites ,169 1 Lung & Bronchus ,151 2 Prostate ,369 3 Colon & Rectum ,218 4 Pancreas ,566 5 Liver & Intrahepatic Bile Duct 9.0 1,168 6 Leukemia 9.2 1,010 7 Esophagus Non-Hodgkin Lymphoma Urinary Bladder Kidney & Renal Pelvis

33 Top 10 Cancer Deaths in SC by Number of Deaths by Sex, Cancer deaths for females ranked by count, Rank Rate Count All Cancer Sites ,944 1 Lung & Bronchus ,772 2 Female Breast ,375 3 Colon & Rectum ,966 4 Pancreas 9.6 1,466 5 Ovary 7.2 1,079 6 Leukemia Uterus/Corpus/NOS Non-Hodgkin Lymphoma Myeloma Liver & Intrahepatic Bile Duct Cancer deaths for males ranked by count, Rank Rate Count All Cancer Sites ,169 1 Lung & Bronchus ,151 2 Prostate ,369 3 Colon & Rectum ,218 4 Pancreas ,566 5 Liver & Intrahepatic Bile Duct 9.0 1,168 6 Leukemia 9.2 1,010 7 Esophagus Non-Hodgkin Lymphoma Urinary Bladder Kidney & Renal Pelvis

34 Female Breast Cancer Incidence by Age Group & DHEC Region Female breast cancer incidence rates for females by SC DHEC region, All Ages South Carolina Low Country Midlands Upstate Pee Dee

35 Cervical Cancer Incidence by Age Group & DHEC Region Cervical cancer incidence rates by SC DHEC region, All Ages South Carolina Pee Dee Upstate Low Country Midlands

36 Female Breast Cancer Mortality by Age Group & DHEC Region Female breast cancer mortality by SC DHEC region, All Ages South Carolina Midlands Pee Dee Upstate Low Country

37 Cervical Cancer Mortality by Age Group & DHEC Region Cervical cancer mortality by SC DHEC region, All Ages South Carolina Pee Dee 2.9 ~ 5.5 Midlands 2.7 ~ 4.9 Low Country 2.5 ~ 4.3 Upstate 2.3 ~ 4.0

38 Questions!

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