(Megan Curran de Nieto)

Community Blood Lead Screening; Navigating Barriers in your Blood Lead Testing Program For those of you who have tried to start a blood lead testing program, you have no doubt come up against some pretty solid barriers to getting your program going. However, the good news is that overcoming those barriers is not an impossible task and it helps to make the program stronger.

Some of the challenges that Community Lead Education and Reduction Corps (CLEARCorps) has faced are: financial sustainability, working with health plans, defining the role within the public health and medical communities, medical staffing, case management, elevated lead level follow-up, educational messages, outreach, collaboration with primary care, and collection methods.

In the next few blogs I will address a few of these issues at a time. I welcome your comments and emails. If you are interested in more information or chatting about specific barriers and challenges that you are facing in your program, please contact me and we can work together!! My contact phone number is 651-603-8000 and email megan [at] clearcorps [dot] org.

Today let’s take a look at how to achieve financial stability by working with health plans. So you have identified that there are children in your community who are not being tested for lead. You have identified your blood lead screening rate and you have made a commitment to increasing that rate. Awesome!! You have decided to head into the community to find and test those at-risk children and test them for lead. The problem is…money is tight and you are concerned about being able to pay for the tests, pay your staff and hired medical professionals. Let’s be real here and face the facts…as much as we want to save the world, much of the time it simply comes down to money.

When it comes to payment for services, health plans can be your best allies. An essential piece to the financial sustainability puzzle is contracts with health plans. Many health plans are willing to negotiate special rates for 36416 (the finger stick). CCUSA’s current rates of reimbursement for 36416 range from $3.50 to $25.00. Imagine 100 children at $25.00 each? In many states the possibility of billing 83655 (blood lead analysis) where the rate of reimbursement seems to range from $9.00 to $27.00 also exists.

Negotiating health plan contracts can be a tricky endeavor. There is a great tutorial written by Christine L. Jones, BS, and Terry L. Mills Jr., MD, FAAFP which can be found in PDF format at http://www.aafp.org/fpm/20061100/49nego.html. This tutorial lays out the basic pieces that need to be well thought out before approaching the plan.

The truth is, if your community organization is attempting to negotiate a contract with a local health plan, you will most likely be asking them to reimburse you for one or two CPT codes. In my experience these negotiations have not been difficult and the plans have been more than willing to accommodate our needs.

CLEARCorps has had successful relationships with the following health plans. Some of the relationships have been contractual and some have been more like working relationships.

Medica (www.medica.com)

HealthPartners (www.healthpartners.com)

UCare Minnesota (www.ucare.org)

Metropolitan Health Plan (www.mhp4life.org)

Blue Plus (www.bluecrossmn.org)

Prime West (www.primewest.org)

First Plan (www.firstplan.org)

South Country Health Alliance (www.mnscha.org)

Despite the challenges, this is a source of income that is worth pursuing. If you and your organization would like further guidance, CLEARCorps USA and I would be EXCITED to help you out!! Please feel free to contact me at anytime and we will get a dialog started.