Family PACT Program Report FY09-10: Overview of Contraceptive Services and Practical Applications for Practice Improvement February 8, 2012 Family PACT Program Report FY09-10: Overview of Contraceptive Services and Practical Applications for Practice Improvement February 8, 2012 Mary Bradsberry and Heike Thiel de Bocanegra, MPH, PHD Bixby Center for Global Reproductive Health University of California, San Francisco Presented by: California Department of Public Health Office of Family Planning (OFP)

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Family PACT Program Report FY09-10: Overview of Contraceptive Services and Practical Applications for Practice Improvement Presenters: Mary Bradsberry and Heike Thiel de Bocanegra, MPH, PHD Bixby Center for Global Reproductive Health University of California, San Francisco Bixby Center for Global Reproductive Health University of California, San Francisco

Description Based primarily on analyses of Family PACT claims data for Fiscal Year (FY) 09/10, this webinar will cover contraceptive utilization among different client groups. Focus will be placed on trends in the use of long-acting contraception, newly available contraceptive methods as well as prioritizing interventions to promote the use of highly effective contraception. 8

Learning Objectives As a result of this training, participants will be able to: 1. Describe contraceptive utilization patterns by specific contraceptive method types and client demographics. 2. Have a better understanding of priority areas for potential interventions to improve quality of care for contraceptive clients. 9

Trend in Number of Clients Served by Family PACT Family PACT Clients and Providers +2.5% +1.9% +0.9% +5.8% +3.1% 10

Clients Served by Family PACT: Females vs. Males 11

Provision of Family Planning Methods by Tier Tier 1 – Long Acting Contraception (LAC) not dependent on client to be effective Sterilization, IUC & Implant Tier 2 – Very effective if used perfectly, user dependent Injections, OCs, Patch, Ring Tier 3 – Less effective, user dependent, subject to higher failure rates Barriers, EC 12

Provision of Family Planning Methods by Tier: Female Family PACT Clients Served, FY

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Profile of IUC Clients Receiving an IUC, FY to FY Over 5 years, among women provided with an IUC The proportion of nulliparous (zero live births) women has increased from 12 to 23% The proportion of women age 19 and under has increased from 6 to 9% The proportion of White women has increased from 12 to 20% The proportion of women with English as primary language increased from 27 to 48% The proportion of women dispensed Mirena IUC has increased from 32 to 50% 16

17 Clients Served with IUC Services as Percent of Total Clients Served, FY to FY

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19 Family PACT Female Clients Provided Sterilization, FY 05/06 to FY 09/10

Family Planning Services for Female Family PACT Clients by Method Tier and Client Race/Ethnicity, FY

21 Male Family PACT Clients Served by Method Dispensed/Provided

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Client Variables Influencing Contraceptive Method Choice Short- and long-term pregnancy intentions Experience (past and present) with contraceptive methods Lack of knowledge or misperceptions of benefits and side effects of contraceptive methods 25

Developing a Reproductive Life Plan (RLP) Function: Help clients think when and under what conditions they want a pregnancy Questions Do you hope to have any (more) children? How many children do you hope to have? How long do you plan to wait until you become pregnant? What do you plan to do until you are ready to become pregnant? What can I do today to help you achieve your plan? 26

Developing a Reproductive Life Plan (RLP) Further details: Talking With Your Clients About a Reproductive Life Plan > Providers > Provider Training > Previously Recorded Webcasts Discuss and document reproductive life plan and contraceptive method choice also with male clients 27

Review Satisfaction and Consistency of Use of Current Method Implement protocols to integrate a conversation on contraception in all Family PACT visits Questions Are you currently using a method (if not known or elsewhere in chart)? Are you satisfied with the method? Do you have any questions or concerns? (If user-dependent contraception) Did you use this method consistently since your last visit? 28

Client-Centered Contraceptive Counseling Client outreach materials for Family PACT providers Go to > Client Education Materialswww.familypact.org 29

Family PACT Client Education Materials 30

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Assess the Demographic Distribution Of Your Practice Compare provider-specific demographic information with program-wide client demographics from annual report Explore how racial/ethnic and age distribution might impact contraceptive method counseling How many nulliparous and how many teens at the clinic receive IUCs and implants? 32

Assess the Contraceptive Mix of Your Practice Identify the contraceptive mix at clinic through chart review and billing records and compare with program data 33

34 EXAMPLE PROVIDER A Clients Served with Contraceptive Services* as Percent of Total Clients Served N=1,996 Female Clients Served in Year Tier 1 Methods Tier 2 Methods *Based on primary diagnosis codes. Tier 3 Method

35 EXAMPLE PROVIDER B Clients Served with Contraceptive Services* as Percent of Total Clients Served N=1,493 Female Clients Served in Year Tier 1 Methods Tier 2 Methods *Based on primary diagnosis codes. Tier 3 Method

Promoting Provision Of Long-Acting Contraception Include discussion on new and long- acting contraception (reversible and permanent) at staff meetings and trainings Identify provider barriers to offering new and long-acting contraception and appropriate interventions to address them 36

Provider Barriers To Long Acting Reversible Contraception (LARC) Dispensing Provider barriers Lack of clinician knowledge or misperceptions Lack of training/skills in procedures Lack of mentoring in performing procedures after the training Policy barriers Clinic protocols impeding immediate insertion 37

Family PACT Provider Practices with IUCs Harper C, et. al. OB GYN 2008; 111: 1359 Survey of 1,246 providers with at least one IUC insertion claim in 2005; response rate 65% (n=813) Providers who think that an IUC should not be placed if client is Nulliparous: 50% Adolescent: 58% Had a history of ectopic pregnancy: 63% 38

Encourage clinicians to participate in OFP and company sponsored training activities IUC insertions Implant insertions Essure procedure Monitor whether clinicians started providing LARCs after training Develop a post-training proctoring system 39

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Information for Clinicians 41

“If the practitioner lacks the specialized skills to provide invasive contraceptive procedures or sterilization, or there is insufficient volume to ensure and maintain a high skill level, clients shall be referred to another qualified practitioner for these methods/ procedures. The enrolled provider shall have an established referral arrangement with the other provider(s) when making referrals for these procedures” 42

Establish referral system with linkages to other Family PACT or Medi-Cal providers who Perform IUC insertions Perform implant insertions Offer male sterilizations Offer female sterilizations 43

How To Make A Successful Referral 1. Establish relationships with other Family PACT and Medi-Cal providers for client referrals. 2. Assist client with making appointment. 3. Provide medical record information to the rendering provider _TipsForReferringAndRenderingP roviders0508_ pdf 44

4. Provide the rendering provider with the required information for billing: Referring provider’s National Provider Identifier (NPI); S-Code primary diagnosis and any secondary diagnosis which may apply to the care being provided to the client; Client’s HAP Card number; For Sterilization procedures, copy of the Sterilization Consent Form (PM 330) ‹ R_TipsForReferringAndRendering Providers0508_ pdf 45

46 Questions & Answers

Contact Information: Mary Bradsberry Heike Thiel de Bocanegra, PhD, MPH

At the conclusion of session complete: 1. Evaluation Form or Zoomerang Survey 2. Sign-in Sheet Please fax these items to Those without web access can get forms by calling FAMPACT ( ) 48 Evaluation and Sign-in

49 File Transfer 1 2 Click File Press Download