Montana Comprehensive Cancer Control

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Montana Comprehensive Cancer Control

• The Montana Breast and Cervical Health Program
• May 9, 2008

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Karan KunzProgram Specialist Manager

• Contract Liaison for administrative site
  contractors to assure statewide screening
  activities
• Ensures program funding through grant writing to
  CDC and other sources such as Komen
• Develop and implement statewide comprehensive
  workplan and budget
• Develop and implement the American Indian
  Screening Initiative
• Develop and implement public education plan
• Implement and maintain the evaluation plan to
  monitor program performance

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Kathy MyersProgram Clinical Quality Manager

• Contract Liaison for Fiscal Agent to assure
  medical service provider reimbursement
• Implement and monitor the quality assurance and
  improvement plan for clinical quality
• Maintain surveillance system and statewide
  database to report the disease burden of breast
  and cervical cancer
• Maintain, coordinate, and manage the Medical
  Advisory Board
• Develop and implement the professional education
  plan
• Assure that women are referred to the Montana
  Breast and Cervical Cancer Treatment Program

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Mary BuckData Manager

• Develop, implement, support, and manage the
  complex statewide data system for collection,
  reporting and analysis of all program data
  elements
• Report minimum data elements to CDC and analyze
  results of MDE submission for MBCHP utilization
• Design and update program forms
• Convert clinical data into weekly internal
  tracking forms for the monitoring of
  administrative site progress
• Provide training to state staff and contractors
  as needed
• Communication Liaison with IMS on behalf of the
  MBCHP

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Charlotte KelleyAmerican Indian Screening
Coordinator

• Provide leadership, support and direction for the
  Montana American Indian Womens Health Coalition
• Design, implement, and evaluate the outreach
  programs for American Indian women
• Design, implement, and evaluate culturally
  appropriate professional education programs
• Provides leadership and direction for
  relationships with American Indian health systems
  staff and providers
• Assist the IHS screening sites with program
  compliance and provide technical assistance for
  screening

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Diane AraveHealth Education Specialist

• Provide leadership, planning, implementation, and
  evaluation related to the educational efforts for
  breast and cervical cancer control
• Design and implement surveys such as the service
  assessment survey which evaluates statewide
  campaigns
• Design, implement, and evaluate three statewide
  public education campaigns which give
  administrative sites opportunities for community
  and 11 outreach
• Provide leadership, direction, and support for
  the public education sub-committee

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Valerie WeedmanAdministrative Accountant

• Provide administrative and accounting support
• Assure MBCHP staff has adequate support to
  complete their roles
• Assure program funds are appropriately assigned
  for re-imbursement within state fiscal system
• Monitor expenditures and balances of all
  contracts
• Manage communications with sites regarding
  meetings and calls
• Manage and maintain web page

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Program Services

• Breast and cervical cancer screening for women 50
  to 64 years of age
• Limited funds for women 40-49 breast screening
• Limited funds for women 30-49 cervical screening
• Regular mammograms and clinical breast exams
  (including office visit)
• Regular pap tests and pelvic exams according to
  CDC guidelines
• Diagnostic services for abnormal tests
• Referral to cancer treatment program if necessary

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MBCHP Target Population

• Public health cancer screening program
• Montana women who are 50 through 64 years of age
• Uninsured or underinsured
• Meet income guidelines of 200 of current federal
  poverty level (1 person 20,800 annually)
• Have rarely or never been screened for cervical
  cancer

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Enrolled Medical Service Providers

• Over 900 enrolled medical service providers
  statewide
• Sign enrollment contract
• Agree to accept fee re-imbursement schedule,
  follow MBCHP screening guidelines set by CDC, and
  adequate follow-up
• Payor of last resort except for IHS

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Administrative site an organization with whom
the MBCHP contracts with to implement the program
in a multi-county area.

• Flathead City-County Health Department Flathead,
  Lincoln, Lake, and Sanders Counties and work with
  Flathead reservation
• Missoula County Health Department Mineral,
  Missoula, and Ravalli Counties and Missoula
  Indian Center
• Lewis Clark City-County Health Department
  Broadwater, Jefferson, Meagher, and Lewis Clark
  Counties and work with Helena Indian Alliance
• Butte-Silver Bow County Beaverhead, Deer Lodge,
  Granite, Madison, Silver Bow, and Powell Counties
  and work with North American Indian Alliance

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• Teton County Health Department Teton, Pondera,
  Glacier, Toole, and Liberty Counties and
  Blackfeet reservation
• Gallatin City-County Health Department Gallatin,
  Park and Sweet Grass Counties
• Cascade City-County Health Department Cascade
  and Chouteau Counties and work with Indian Family
  Health Clinic
• Yellowstone City-County Health Department Big
  Horn, Carbon, Golden Valley, Musselshell,
  Stillwater, Treasure, and Yellowstone Counties
  and Tribal Leaders Council (urban)
• Blaine County Health Department Blaine, Hill,
  and Phillips Counties and Rocky Boy and Fort
  Belknap reservations
• Central Montana Family Planning Fergus, Judith
  Basin, Petroleum, and Wheatland Counties

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• Daniels County Health Department Daniels,
  Roosevelt, Sheridan, and Valley Counties and Fort
  Peck reservation
• Custer County Health Department Custer,
  Garfield, Carter, Powder River, and Rosebud
  Counties and Northern Cheyenne and Crow
  Reservations
• Richland County Health Department Dawson,
  Fallon, McCone, Prairie, Richland, and Wibaux
  Counties

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Administrative Sites

• 13 administrative sites provide statewide
  screening services
• 7 sub-contracts provide services to 3 urban areas
  and 6 reservations
• 1 reservation receives services through local
  administrative site
• 2 urban areas receive services through local
  administrative sites
• 2 administrative sites have small American Indian
  screening goals

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American Indian Screening Initiative

• Reservations and Tribes
• Blackfeet Reservation (Blackfeet Tribe)
• Crow Reservation (Crow Tribe)
• Flathead Reservation (Salish Kootenai Tribes)
• Fort Belknap Reservation (Gros Ventre
  Assiniboine Tribes)
• Fort Peck Reservation (Assiniboine Sioux
  Tribes)
• Northern Cheyenne Reservation (Northern Cheyenne
  Tribe)
• Rocky Boy Reservation (Chippewa Cree Tribes)
• Little Shell Tribe of Chippewa Indians of Montana
  Headquarters, Great Falls

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American Indian Screening Initiative

• Urban Indian Centers
• Indian Family Health Clinic Great Falls
• Indian Health Board of Billings Clinic Billings
• Leo Pocha Clinic Helena
• Missoula Indian Center Missoula
• North American Indian Alliance - Butte

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American Indian Screening Initiative Phase II

• Focus is on mammography screening and outreach
  efforts on the program priority population of
  American Indian women living in Montana
• Administrative sites provide resources and
  program expertise for AI sub-contractors
• Sub-contractors provide local resources and local
  Indian health system expertise to enhance
  screening
• State office facilitates communication and
  provides training

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Scope of the responsibility for Public Law
101-354

• 60 percent of the financial distribution must be
  spent for screening, tracking, follow-up and
  screening support services for MBCHP clients.
• 40 percent of the distribution must be spent for
  program management, outreach and public
  education, professional education, quality
  assurance and improvement, coalitions and
  partnerships, and surveillance and evaluation.

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Program Screening

• 2007-2008 budget 2,209,628 with 65 screening
  (1,437,119) and 35 administration (772,509)
• Program screening goal 4,738
• Program American Indian screening goal 667
• Current progress goal 3,216
• Current progress AI goal 437
• Mammograms 2,511
• Pap Tests 1,730

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Core Performance Indicators

• Breast
• 98 of abnormal breast findings had workup
  completed (goal gt90)
• 7.5 of abnormal breast findings had workup
  completed beyond 60 days (goallt25)
• 0 of diagnosed breast cancer cases initiated
  treatment beyond 60 days (goallt20)
• 86.4 of screening mammograms performed on
  women gt50 years of age (goal75)

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Core Performance Indicators

• Cervical
• 98.2 of abnormal Pap findings had workup
  completed (goalgt90)
• 22 of abnormal Pap findings had workup
  completed beyond 60 days (goallt 25)
• 4 of diagnosed pre-cancers and cancers
  initiated treatment beyond 60 days (goallt20)
• 27.8 of women were never/rarely screened for
  cervical cancer (goalgt20)

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MBCHP Website

• Web Address www.cancer.mt.gov
• Information on webpage
• Policy and Procedure Manual
• Administrative Site Information
• Medical Service Provider Information
• Eligibility
• American Indian Screening Initiative
• Outreach Activities

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Providers perspective

• Lorinda Doede, RNC NP Bridger Clinic, Inc
• Provider for MBCHP clients
• Number of women helped
• Ages of women helped
• Referral sources
• Issues/concerns