1. Joanne Roberts, PHN Perinatal Services Coordinator Los Angeles County November 8, 2012 Integrating Interconception Health into CPSP

2. Recommendations for The Postpartum Visit ACOG: – Recommend four to six weeks postpartum – General assessment of physical and mental well-being –Special emphasis on depression screening, breastfeeding, and contraception

3. Recommendations for the Post Partum Visit World Health Organization: Recommend contact with the health care system: “six hours, six days, six weeks and six months” post-delivery Improved postpartum care will not only improve the health and well being of the postpartum woman but will also improve outcomes of subsequent pregnancies

4. The Facts: Postpartum Visit & CPSP Common belief: one pp visit at 4-6 weeks Providers have minimum 3 ½ hours postpartum –Health education –Nutrition –Psychosocial services Additional time (4 hours) Perinatal Education (Z6410) if not all used prenatally

5. The Postpartum Visit & CPSP Perfect opportunity to discuss interconception care Begin with review of prenatal medical records: OB and CPSP

6. The Postpartum Visit & CPSP Challenges: Delivery Record –Often missing from charts –Key to identifying potential risks for future pregnancies

7. Postpartum Visit Compliance Patient Provider Systems

8. Addressing Compliance Stress the importance of the postpartum visit: –Client Orientation –Initial Assessment –2 nd and 3 rd Trimester Reassessments –Post-delivery contact All team members – every opportunity

9. Los Angeles County Projects to Incorporate Interconception Care Messages added to CPSP Training ABCDE’S –Train the TrainerTrain the Trainer –ABCDE’S for CPSP Providers CPSP Postpartum Project

10. ABCDE’S

11. CPSP Training

14. Training at provider office (1 hour): Described PCC and ICC; ABCDE’S Overlap of PCC/ICC with CPSP Used sample Care Plan to identify the risks that have not resolved during pregnancy Discussed CPSP billing codes that can be used for interconception care during postpartum LA County CPSP Postpartum Project

15. Trained 12 sites:103 CPHWs Reviewed 10 CPSP charts per site and documented postpartum services and billing on data collection tool Follow-up 1-2 months post-training to review new postpartum charts Compare pre- and post-training services and billing

16. CPSP Postpartum Project

17. Procedure Code DescriptionWhen to Use Max Units of Service Reimbursement Max Reimbursement Z6208 Postpartum Nutrition Assessment, Treatment, and/or Intervention, including update of Care Plan, Individual. 1) Postpartum nutrition assessment; 2) Postpartum nutrition intervention 4$8.41$33.64 Z6308 Postpartum Psy Assess. Treatment, and/or Intervention, including update of Care Plan 1) Postpartum psy assessment; 2) Postpartum psy intervention 6$8.41$50.46 Z6414 Postpartum Health Education Assessment, Treatment, and/or Intervention, including update of Care Plan 1) Postpartum health education assessment; 2) Postpartum health education intervention. 4$8.41$33.64 Z6410 Perinatal Education, Individual, each 15 min Individual education provided prenatally or postpartum 16$8.41$134.56 Z6412 Perinatal Education, Group, per patient, each 15 minutes (Maximum 4 hours/day,18 hours/pregnancy) Group education Can be used during Perinatal and during Post Partum period 72$2.81$202.32

18. 18% Improvement

19. Project Challenges Difficult to schedule follow-up visits Many providers don’t do CPSP postpartum Difficult to measure results –How can we measure increase in ICC services? –Comparing number of postpartum services billed was not effective

20. http://www.everywomancalifornia.org RESOURCES

21. www.cdph.ca.gov/programs/preconception

22. RESOURCES Visit ph.lacounty.gov/mch/  Select “Preconception Health”

23. Thank you! jroberts@ph.lacounty.gov