1. Conflicting Laws and Innovative Approaches
Can Providers Assure Commercially-Insured Adolescents Confidentiality for STI Screening and Treatment?
Conflicting Laws and Innovative Approaches
Gale R Burstein, MD, MPH, FAAP
Erie County Department of Health
Buffalo, NY

2. Provider Strategies to Assure Confidentiality with Billing
Individual-Level
Systems-Level

3. Individual Provider Strategies
What are they doing?
Survey of providers caring for adolescents
Posted on provider listserves
Society for Adolescent Medicine (SAM)
American Academy of Pediatrics Section on Adolescent Health (AAP/SOAH)
~40 responses
1430 Physicians:  1089 or 78% All Other Adolescent Health Providers:  313 or 22% SAM-L is open to members and non-members (as long as the non-members "register" with the national office): 1065
AAP: 60,000 pediatricians
SOAH: 675 members

4. Individual Provider Strategies
“This is a perpetual problem…… Right now, I basically tell patients that their parents can get an EOB and that they should go to Planned Parenthood, their school-based clinic, give the hospital lab an alternative address for the bill or pay cash for laboratory testing to bypass their parent's managed care plan.”
“Guaranteeing confidentiality can be a trap, because there is no little in our control.”

5. Individual Provider Strategies
“Creative coding” for office visit
Encourage teens to disclose to parents
Teen can pay out of pocket
Flexible spending health accounts and high-deductable plans create new challenges

6. Systems-level Provider Strategies
Work with health plans to change EOB text
Example: 3 Western NY health plans
“Laboratory”
“Laboratory Services”
“LAB/Clia Test”
STD services/test codes in “confidential” class
EOB reads as “medical service”

7. Public Health Strategy
Local Health Department-Level

8. Partner with Provider Groups
State medical and nursing societies
State medical professional organization chapters
i.e., AAP, AAFP, ACOG, SAM
Local medical professional societies
AAP Pediatric Councils

9. Erie County Department of Health Strategy
Example of Local Health Department-Level Strategy

10. Adolescent Reproductive Health Care Tool Kit
Tools to overcome barriers to office-based confidential sexual health care service delivery
Billing
Private time with teen
Gaining parental acceptance for confidential services
Referral resources

11. Adolescent Reproductive Health Care Tool Kit: Contents
Billing/coding fact sheet
ICD9 and CPT Codes
Vignettes as models for use
Parent brochure
Office can personalize with name and logo
Download state YRBS risk behavior data
Table of all CT and GC tests

12. Adolescent Reproductive Health Care Tool Kit: Contents
Tips for office
Maximizing office confidentiality
Making office teen friendly
How to perform “atraumatic parentectomy”
Available at:
AAP/SOAH web
NACCHO tool box web

13. Public Health Reaching Providers:
Tool Kit Dissemination via Academic Detailing

14. Academic Detailing Office-based educational intervention with food
Based on Pharma model
Successful in changing providers behaviors

15. Promoting Adolescent Reproductive Health Project (PARHP)
Goals:
Improve confidential adolescent sexual health care access
Increase CT screening for sexually active teen ♀
Partners
Foundation for Healthy Living
NYSDOH Bureau of STD Control
3 local health plans

16. PARHP Methods
Work with health plan (BCBS of WNY) to develop list of 50 primary care and 25 OBGYN offices with highest teen patient volume
Academic detailing to offices with tool kit and lunch

17. PARHP Tool Kit Content: Additional Erie County Content
PRCH Minor Access Cards
Summarize laws surrounding the provision of sexual health services to minors in 11 states
AAP Teen Health Care Bill of Rights
List of local low- or no-cost clinics for sexual health care services
Reporting information

18. PARHP Evaluation Chlamydia Screening HEDIS data
Pre- and post-intervention
By office
By provider
Provider pre- and post-test KAP survey

19. Questions