Breast cancer screening rate dropping sharply among Arkansas Medicaid beneficiaries

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1 A Publication of Medicaid Managed Care Services (MMCS) and the Arkansas Department of Human Services VOLUME 11 ISSUE 1 WINTER 2012 INSIDE n FYI: Get it Right from the Start! New DHS website offers information for parents of young children Page 3 n POLICY UPDATE: Medicaid strengthens antipsychotic prescriptions policy for children Page 4-5 n REMINDERS: Pregnant women s flu vaccination rates lag Page 6 n QI UPDATE: Room to improve after-hours access to primary care, survey shows Page 7 Breast cancer screening rate dropping sharply among Arkansas Medicaid beneficiaries n Other women s health screenings show slight improvement ewer than three out of 10 female n BREAST CANCER: The mammogram Medicaid beneficiaries in Arkansas screening rate for Arkansas Medicaid beneficiaries declined sharply for the second ages 40 through 69 had undergone a screening mammography in the previous two years, according to data of beneficiaries ages 40 to 69 who had a mam- straight year. HEDIS measures the percentage from the mogram during the Healthcare Effectiveness Data and In SFY 2009, previous two years. Information Set the rate was 29.8 (HEDIS, a registered trademark from 34.1 percent percent, down of the National in SFY 2008 and Committe for 37 percent in SFY Quality Assurance) In contrast, covering state fiscal the national year The rate Medicaid rate dropped more than increased slightly four percentage from 50.1 percent points from SFY in SFY 2008 to 2008, continuing a 50.5 percent in decline that began in SFY Other HEDIS SFY 2009 although that is still below the women s health measures for SFY 2009 the 54.7 percent mark from SFY most recent data available show room for improvement as well. See WOMEN, page 2

2 WOMEN, continued from front REPORT Helping you stay on top of quality in your practice Women patients may be confused by conflicting recommendations on the age at which they should start having regular screening mammograms. The U.S. Preventive Services Task Force revised their recommendation in 2009 to state that routine screening should begin at age 50 unless individual women in consultation with their physicians choose to begin screening earlier. Several other national groups, however, including the American Cancer Society and the American College of Obstetricians and Gynecologists, still recommend beginning at age 40. Medicaid covers screening mammograms beginning at age 40. Physicians can help improve the screening rate by making sure to talk to female patients in the appropriate age range about the importance of regular screening mammograms, and taking advantage of automated reminder systems to flag patients who are due or overdue for mammograms. n CHLAMYDIA: HEDIS measures the percentage of women ages 16 through 24, identified as sexually active, who had at least one test for chlamydia during the measurement year. Arkansas s chlamydia screening rate actually increased substantially, rising from 48.1 percent in SFY 2008 to 57.3 percent in SFY The SFY 2009 rate surpassed the national Medicaid rate of 54.8 percent for the same time period. Routine chlamydia screening is essential to treating the disease successfully because about 75 percent of infected women have no symptoms. Approximately 2.3 million people in the Breast cancer screening rates, Arkansas vs. national SFY 2005 SFY 2006 SFY 2007 SFY 2008 SFY % 50.0% 100.0% United States between the ages of 14 and 39 are infected each year. n CERVICAL CANCER: Although screening rates for cervical cancer rose from 41.1 percent in SFY 2008 to 43.5 percent in SFY 2009, Arkansas s rate still lags dramatically behind the national rate of 67.6 percent. This measure is defined as the percentage of women ages 21 through 64 who had at least one Pap test to screen for 38.8% 37.9% 37.0% 54.7% 53.9% 49.2% 34.1% 50.1% 29.8%* 50.5% cervical cancer during the previous two years. The Arkansas Foundation for Medical Care (AFMC), under contract with the state Division of Medical Services, has developed women s health intervention tools for both providers and beneficiaries available at no charge through AFMC s website at These include chart reminder stickers and mammography referral slips. s Arkansas National *Indicates a statistically significant change from the previous year s rate. For more information about any of the projects or stories mentioned in this publication, please call Tereasa Holmes at , ext. 8676, or visit THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MP2-MMCS.NEWS,4-12/11 PAGE 2 MMCS Update WINTER 2012

3 FOR YOUR INFORMATION Get it Right from the Start n New DHS website offers information for parents of young children The Arkansas Department of Human Services has introduced Healthy Families, a new resource for families in Arkansas and western Tennessee that provides information about the health, safety and well-being of children from before birth through age 5. Healthy Families began almost 20 years ago as the Campaign for Healthier Babies and was later branded Healthy Baby. The campaign used the Happy Birthday Baby Book to encourage pregnant women to seek early and continuous prenatal care in hopes of improving birth outcomes and quality of life for both mother and child. Today Healthy Families strives for this goal and more. Its strategies have expanded, too. They include the production of: net n An updated Happy Birthday Baby Book: Book One (prenatal through age 1) to be released in 2012 n A new Happy Birthday Baby Book: Book Two (newborn through age 5) to be released in 2012 n An online platform, www. HealthyFamiliesNow.net, with A-Z resources, online order forms, hot topics, e-newsletter sign-up and more Healthy Families is constantly evolving and adding new resources and materials to help Arkansans and West Tennesseans care for their families. Our goal is the same as yours to keep families healthy and happy. Visit net to learn more and become connected to Healthy Families. s Questions? Need to schedule an MMCS Provider Relations visit? Call or toll-free and contact your provider representative below: Tereasa Holmes, Manager ext Becky Andrews ext Gloria Boone ext Amelia Elam ext Sheryl Hurt ext Tabitha Kinggard ext Teresa McFarland ext Kellie Cornelius ext Connie Riley ext Shawna Branscum, Program Coordinator ext MMCS Update WINTER 2012 PAGE 3

4 POLICY UPDATE News on Medicaid policies & procedures Medicaid strengthens antipsychotic prescriptions policy for children Safety is goal of requiring informed consent and monitoring of side effects rkansas Medicaid has added new requirements to its policy on prescribing antipsychotic medications for children and adolescents under age 18. The new requirements address concerns about overprescribing and the possibility of serious biological side effects. Medicaid now requires prior authorization for all new prescriptions of typical and atypical antipsychotic medications for children and adolescents under age 18, and will require prior authorization for all established patient renewals in that age group beginning June 12, Prior authorization requests must include a signed informed consent and baseline fasting blood glucose and lipid profile. In addition, providers must submit a brief justification for approval for prescriptions for children under age 6. This justification will be manually reviewed by a pediatric psychiatrist. The policy applies to the medications listed in Table 1. New patients are those who have not had a Medicaid claim filled for a prescription for any of the listed drugs in the past six months. As of Nov. 8, 2011, an informed consent must be submitted TABLE 1. TYPICALS Chlorpromazine Fluphenazine Haloperidol Loxapine Molindone Perphenazine Pimozide Thioridazine Thiothixene Trifluoperazine for all new patients. Prescribing providers are also required to submit copies of the completed lab testing when the new drug is prescribed. As of June 12, 2012, an informed consent will also be required for patients using a newly prescribed drug, even if they were previously using another drug on the list. ATYPICALS Aripiprazole Clozapine Olanzapine Olanzapine + fluoxetine Paliperidone Quetiapine Risperidone Ziprasidone Established patients are those who are already being prescribed an antipsychotic and have a Medicaid claim for a drug in the above chart in the past six months. Beginning June 12, 2012, the Medicaid pharmacy program s point of sale system will verify if the required lab work has been completed and billed. If the lab work has been billed in the past nine months and the medication has not changed, the prescription will pay at the pharmacy. If not, the physician may contact the EBRx call center and ask for a one-month approval. The required testing must be completed within the approved month. The number of children prescribed antipsychotic medications has been rising continually for 20 years. In Arkansas, one study found that the number of children prescribed secondgeneration antipsychotics more than doubled from 2001 to Moreover, a large proportion 41.3 percent of new users had not been diagnosed with a disorder for which any evidence existed for the use of atypical antipsychotics. In contrast, other interventions such as family therapy, behavior therapy and parent management training are underused. Psychosocial interventions should be tried before medication, according to the American Academy of Child and Adolescent Psychiatry s practice parameters for the use of atypical antipsychotic medications. Children who use these medications can also suffer serious side effects, including weight gain, hyperglycemia, new onset diabetes, alterations in the lipid profile, cardiovascular abnormalities, movement disorders and hyperprolactinemia, that increase the risk of morbidity and mortality. It s also unknown how these medications affect children s still-developing brains. Arkansas Medicaid began monitoring trends in the prescription of atypical antipsychotics in children several years ago, and in July 2009 began requiring prior authorization for antipsychotic prescriptions for children younger than 5 years old. The new policy also placed limits on the dosage of prescriptions of these medications for children younger than 18. In forming the latest policy changes, the Arkansas Department of Human Services worked with child psychiatrists, psychiatrists, pediatricians and pharmacists. This collaboration settled on an informed consent as the best way to ensure family participation in treatment, and created a form with specific instructions for monitoring biological side effects (weight, lipid profile, fasting blood glucose). More details about the new policy as well as downloadable sample informed consent forms and flowsheets for monitoring side effects can be found at and s These sample documents, an informed consent and a flowsheet for monitoring biological side effects of antipsychotic medications, are available at no charge from AFMC s and Arkansas Medicaid s websites. PAGE 4 MMCS Update WINTER 2012 MMCS Update WINTER 2012 PAGE 5

5 REMINDERS Important updates you need to know Pregnant women s flu vaccination rates lag n Prenatal care provider reminders make a difference Pregnant women have the lowest influenza vaccination rate of all adult priority groups in Arkansas. The numbers are even lower for pregnant women on Medicaid. In a survey conducted by the Centers for Disease Control and Prevention s Pregnancy Risk Assessment Monitoring System (PRAMS) covering the flu season, less than half the women who responded to the question (46.7 percent) said they had received an influenza vaccine. The percentages were even lower for women under the age of 19 (39 percent), African-American women (35.1 percent), women who received no prenatal care in the first trimester (36.2 percent), women who were on Medicaid (37.5 percent vs percent of women not on Medicaid), and women whose provider did not recommend the vaccination (19.4 percent, compared to 59.1 percent of women whose provider did recommend it). Influenza vaccination is especially important for pregnant women because the changes that occur during pregnancy leave them more vulnerable to the illness and its complications. Vaccination during pregnancy also protects women s babies until they can be vaccinated themselves. Studies have shown that pregnant women are much more likely to get a flu shot if their prenatal care provider recommends or provides it. In fact, 30 percent of pregnant women in the survey who said they hadn t been vaccinated listed My doctor didn t mention anything about a flu shot as one of the reasons. The CDC suggests the following steps for providers to help increase the number of pregnant women who are vaccinated: n Educate staff and pregnant women about the importance of influenza vaccination during pregnancy and evidence related to its safety, and provide a strong recommendation for vaccination. n Issue standing orders for influenza vaccination of pregnant and postpartum women. n Establish an influenza vaccination reminder system in their practices n Post influenza prevention announcements and provide brochures to prompt vaccination requests. n Offer vaccination to pregnant women at the earliest opportunity and throughout flu season (October April). n Vaccinate postpartum women who were not vaccinated during pregnancy, preferably before hospital discharge or at the sixweek postpartum visit. n Know where to refer patients if influenza vaccine is not available in the practice. n Educate staff and postpartum women that vaccination is safe for breastfeeding women and babies. n Advise family members and other close contacts of pregnant and postpartum women and infants that they should also be vaccinated against influenza. s PAGE 6 MMCS Update WINTER 2012

6 QI UPDATE Helping you stay on top of quality in your practice Survey shows room to improve after-hours access to primary care n Almost half of practices route calls to answering machines T he results of a recent survey of Medicaid-enrolled primary care physicians suggest that the majority of PCPs surveyed are meeting Medicaid requirements for after-hours communications with patients, but there is room to improve, particularly in rural areas. Medicaid requires enrolled PCPs to provide parients 24-hour/seven-days-aweek access to a live voice (clinic staff or an answering service) or an answering machine that will immediately page an on-call medical professional. The on-call professional must respond to non-emergency calls within 30 minutes, and must provide information and instructions for treating emergency and non-emergency conditions; make appropriate referrals for non-emergency services; and provide information about accessing other services and handling medical problems when the PCP s office is closed. The Arkansas Foundation for Medical Care (AFMC) re cently surveyed Medicaid primary care physicians with a caseload of at least 100 about the after-hours access they provide to patients. Of the 801 providers contacted, 456 completed the survey, which was done at the request of the state Division of Medical Services. Highlights of the results include: n Overall, 55 percent of responding providers offer an after-hours call system where patients are able to speak with a live person, such as clinic staff or an answering service. n More than 40 percent of practices, however, offer only an answering machine that is not checked until the practice reopens. Of these, 70 percent tell patients to leave a message and go to the ER in case of an emergency, while 30 percent tell patients to call an answering service. n Less than 12 percent of providers use a clinical triage service such as a nurse hotline to answer after-hours calls. n Less than 3 percent of providers offer direct contact with an on-call physician after hours. n At least one in three providers uses an answering service. At least half of these page an on-call professional who responds within 20 minutes. n Of 93 phone calls made for verification, 69 providers (74 percent) had after-hours systems that matched their survey responses, while 24 providers (26 percent) systems did not match.. n AFMC also called providers who did not complete the survey to determine if their after-hours calls system differed from providers who did complete the survey. Providers who answered the initial phone call but did not complete the survey were significantly more likely to use answering machines and significantly less likely to use answering services compared to providers who completed the survey. All answering services from both verification groups stated that the practice responds within 20 minutes and that the answering service, if requested, will send a log of all calls to the practice. DMS is interested in working with clinicians across the state to improve access as envisioned by the original Primary Care Case Management concept. Please send your comments to Gary Wheeler, MD, at gwheeler@afmc. org, Tereasa Holmes at tholmes@afmc.org, or Julie Kettlewell at jkettlewell@afmc.org. s MMCS Update WINTER 2012 PAGE 7

7 1020 West 4th Street Suite 200 Little Rock, AR PRESORTED STANDARD U.S. POSTAGE PAID LITTLE ROCK, AR PERMIT # 2234 ADDRESS SERVICE REQUESTED Coming this spring and summer to a site near you, the FREE FOR MORE INFORMATION VISIT OR CALL TOLL-FREE , EXT COMING SOON! IN THIS ISSUE New DHS website offers information for parents of young children Medicaid strengthens antipsychotic prescriptions policy for children Pregnant women s flu vaccination rates lag Survey shows room to improve after-hours access to primary care n March 8, 2012 Texarkana n April 12, 2012 Bentonville n May 23, 2012 Jonesboro ARKANSAS MEDICAID Managed Care Educational Conferences For more information on the material in this publication, contact Medicaid Managed Care Services at or visit n August 2, 2012 Magnolia 2012