Pennsylvania (1st Cohort)
About the Team
The Pennsylvania team is working to reduce geospatial disparities in sexually transmitted infection (STI) screening and diagnosis rates among 15-20-year-old Medicaid managed care beneficiaries. The Pennsylvania team is comprised of:
Identifying and Diagnosing the Problem
The Pennsylvania team began the AHE initiative by conducting several analyses to understand what health disparities exist within their Healthcare Effectiveness Data and Information Set (HEDIS) metrics. The team initially identified disparities in adolescent well child visits (AWC), yet focused on improving the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) metrics, which encapsulates AWCs. The team also considered the 2019 State of Health Equity in Pennsylvania report which outlined sexual health inequities as an area of concern. The team decided to focus on improving sexually transmitted infection (STI) screening and diagnosis rates via the Medicaid EPSTD benefit.
The team conducted a root cause analysis by engaging several departments across the partnering organizations and engaging adolescent members through survey at community events and case managers at Highmark Wholecare, to learn key insights and barriers adolescents from socially disadvantaged neighborhoods face when seeking sexual health care.
Designing and Implementing Change
The results from the team’s root cause analysis led them to devise the following strategies to improve sexual health screening, education, social needs screening, and referrals:
- Universal, opt-out STI (chlamydia and gonorrhea) screening as part of EPSDT benefit. Originally, adolescents only received testing based on self-reported risk history and symptoms. Now, to meet EPSDT protocols, practices must conduct opt out STI screening for all 15–20-year-olds as part of their annual visits.
- Health care provider education on the existence of inequities, new procedures, and incentives.
- Patient education on sexual health and STI screening. The team is using several different mediums for education outreach, including a newsletter through Highmark Wholecare and social media. They have also developed a short educational video on STIs to post on the Highmark Wholecare website.
Lessons Learned
Oftentimes, equity initiatives will not see a return on investment for many years, and when that return on investment is realized it may not be received by the same health plan but, rather, other health plans, the state Medicaid agency, or the broader community. Given this challenge, innovative strategies may be necessary to maintain financial buy-in from organizational leadership. The team has learned that attaining equity is a long term process that requires collaboration from multiple stakeholders, with member involvement being a critical component of success.