The CPI has become a popular and respected forum for providers, payers, and the public health community of New Mexico to discuss prevention policy and make suggestions for translating new research into policy. For example, the Chlamydia and Gonorrhea Screening and Treatment workgroup recently requested that CPI support expedited partner therapy (EPT), in which medication is offered to patients with chlamydia and gonorrhea to give to their sex partners—a practice supported by recent randomized trials and CDC recommendations.
The CPI executive committee reviewed the request and supporting data and subsequently drafted a resolution regarding EPT for sexually transmitted diseases (STDs)—consistent with the most current version of CDC and NMDOH guidelines—which was passed by the NMMS House of Delegates in May 2006. The proposal was then forwarded to the New Mexico Medical Board, which met in mid–2006 and agreed to revise the New Mexico Medical Practice Act regulations on medical ethics (section 16.10.8) to allow for exempting treatment of STDs in accordance with guidelines from the Department of Health. The change to the Medical Practice Act went into effect on January 5, 2007.
Research is encouraged by CPI to address knowledge gaps and increase effectiveness of workgroups. For instance, the Colorectal Cancer Screening workgroup conducted a survey of New Mexico gastroenterologists, which identified additional potential colonoscopic capacity in the state, as well as limitations to an endoscopic-only approach to meeting population screening goals.10
CPI quarterly steering committee meetings are well attended with representation from most health-related organizations in New Mexico. This forum is expanded by CPI's role as a clearinghouse for speakers for professional meetings occurring throughout the state. These include the New Mexico Chapter of the American Academy of Family Physicians, the American College of Physicians, the New Mexico Academy of Physician Assistants, the New Mexico Dental Association, and the New Mexico Society for Respiratory Care. During the 2005 New Mexico legislative session, the CPI was invited to present prevention options to the full New Mexico Senate on the three prevention priorities chosen by the governor of New Mexico—healthier weight, unplanned pregnancy, and childhood immunizations—that coincided with established CPI workgroups. Physician members presented an overview of each problem and explained how the CPI was addressing it in an educational forum that included Senate participation in an active question-and-answer session. CPI activities have been presented at seven national conferences and materials have been solicited from the CPI office by 13 states.
The CPI forum has also increased awareness by the NMMS and other clinician groups of the public health perspective, which has served to consolidate policies and positions supporting clinical prevention within the NMMS. Similarly, the medical directors and staff of the health plans in New Mexico are increasingly invested in preventive health, as demonstrated by their active participation in the CPI and health plan utilization of CPI materials to unify and simplify communication with participating practitioners. This engagement in CPI by the health plans has facilitated provider reimbursement, a critical factor to the enhanced delivery of CPS.
The CPI addresses barriers to reimbursement through a Payer Liaison Group comprised of senior coding and claims managers from each of the health plans, Medicaid, and Medicare. When a CPI workgroup requires input or offers recommendations on coverage or claims coding issues, it may send representatives to meet with or submit questions to the Payer Liaison Group. Information from the Payer Liaison Group is often included in materials developed by the CPI workgroup. For example, CPI was able to verify health plan coverage of billing codes for specific interventions, including: counseling and coordination of care time overrides for selection of evaluation and management codes (E and M codes); diagnostic codes related to promoting healthier weight and screening for problem drinking and intervention; and to determine reimbursable codes for tobacco cessation counseling. CPI was also able to remedy a coding inconsistency between Medicare Advantage plans that was a cause of rejected claims for pneumococcal vaccine administration.
Another essential component of prevention is establishing an evaluation plan and selecting appropriate indicators for that plan. Individual workgroups are tracking process and outcome indicators that may prove useful for determining CPI effectiveness (the ). Several of these indicators suggest that CPI workgroups have made an impact on health. In 2003, in response to low state childhood immunization rates and the impression by providers of a drop-off in visits for well child care in the second year of life, the CPI Childhood Immunization workgroup introduced a more aggressive immunization schedule that consolidates the Advisory Committee on Immunization Practices (ACIP) recommendations into shorter time frames to accomplish full immunization by age one ().11
In the 2005 National Immunization Survey (NIS) conducted by CDC, the New Mexico rate for the cumulative vaccine series in children 19–35 months of age increased by 13.8% from 2002 to 2005 (the ). New Mexico now ranks 36th in the U.S., up from 49th in 2002.12
Practices using the Done by One program in New Mexico have shown improvement in their 4:3:1:3:3 coverage rate—a benchmark indicator used nationally by health authorities and health plans—when compared to practices not using the program. (Personal communication, Steve Nickell, PhD, Director, New Mexico Immunization Program, November 2005.) Based on CPI's experience, the Done by One program has been adopted by Oklahoma and Louisiana.
Indicators for Clinical Preventive Initiative workgroups, New Mexico, 2000–2004
The CPI Tobacco Use Avoidance and Cessation workgroup's activities include extensive provider training and participation in the expansion of insurance coverage for tobacco use cessation services13
(). The NMDOH Tobacco Use Prevention and Control Program reported that the percentage of New Mexico smokers who visited a health-care provider in the past year and were advised to quit smoking increased from 49% in 2001 to 68% in 200314
(the ). Though this change cannot be directly or completely attributed to the CPI's activities, the emphasis placed by the Tobacco Use Avoidance and Cessation workgroup on provider education strengthens the argument for an association. Although modest, the apparent downward trend in prevalence of cigarette smoking from 23.6% in 2000 to 20.3% in 2004 may reflect an impact of tobacco use prevention and cessation efforts in New Mexico, including those of CPI (the ).
The proportion of the population aged 50 and older screened for colorectal cancer increased from 46.8% in 2002 to 54.8% in 2004 using the combined measure of fecal occult blood testing (FOBT) in the past one year or having received endoscopic (flexible sigmoidoscopy or colonoscopy) in the last 10 years. This substantial increase suggests an impact of colorectal cancer prevention efforts, including those of the CPI Colorectal Cancer Screening workgroup ( and the Table). Finally, the increasing proportion of young women screened for chlamydia by New Mexico's managed-care organizations—all of which are active participants in CPI—indicates progress in implementing this relatively recent prevention recommendation.