About the Team
The Pennsylvania team is working to reduce disparities in sexually transmitted infection (STI) screening and diagnosis rates among 15-20-year-old individuals of color. 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 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), which encapsulates AWCs. The team also considered the 2019 State of Health Equity in Pennsylvania report which outlined sexual health inequities. The team decided to focus on improving screening and diagnosing sexually transmitted infections (STIs) via the EPDST benefit.
The team conducted a root cause analysis by engaging several departments across the partnering organizations and engaging individuals through case managers at Highmark Wholecare, to learn key insights and barriers adolescents of color face when seeking sexual health care.
Designing and Implementing Change
The team is pursuing a few different strategies to improve sexual health screenings, education, and the screening and addressing of social needs.
- The team is implementing a universal, opt-out STI (chlamydia and gonorrhea) screening as part of EPDST. Originally, adolescents only received testing based on risk history and symptoms. Now, all 15-20 year olds receive STI screening as part of their annual visits. The universal STI screening will be integrated into the EPSDT benefit, which means that for a practice to meet the EPSDT screening protocols, they need to conduct an STI screening.
- The team created a set of bonus payments to further incentivize conducting STI screenings. For every STI screening that is conducted for an adolescent, the clinic receives a bonus payment. If the adolescent is an adolescent of color, the clinic receives an additional payment.
- The team has created bonus provider payments for screening adolescents for their social needs and referring them to community based organizations.
- The team is creating a provider education component to educate providers on the new procedures and incentives.
- Lastly, the team is creating a patient education component to amplify education on sexual health and STI testing. The team is using several different mediums for education outreach, including a newsletter through Highmark Wholecare, and have plans to use social media such as Twitter and Facebook in future outreach efforts.
In order to obtain approval for the financial incentive, the team offset the program with other programs that would yield a higher financial return. Oftentimes, equity initiatives will not see a return on investment for many years, and when that ROI is realized it may not be realized by the health plan, but by other health plans or the broader community. Given this challenge, innovative strategies may be necessary to ensure the necessary leadership and financial buy-in is obtained.