1. Jacksonville Long-acting Reversible Contraception (LARC) Pilot
Eina G. Fishman, MD, MS, CPE
Chief Medical Officer, United HealthCare Florida Plan
March 8, 2017

2. What is the issue? Unplanned pregnancies are a major challenge
Unplanned pregnancies are associated with delayed prenatal care, premature birth, low-birth weight and other health complications
64% of infant deaths were related to unplanned pregnancies
45% of women reported unprotected sex before their post partum check up
Medicaid State programs cover nearly 2/3 unplanned pregnancies (1.7 million births a year), spending over $10 billion dollars on these births annually

3. Addressing Reproductive Health
*Florida Statistics Compared to National Data
Ranked 33rd in the nation for overall health
Ranked 40th in the nation for health disparities (i.e., 39 states are doing better)
Ranked 35th in the nation for low birth rate at 8.5% (i.e., 34 states are doing better)
Ranked 46th in the nation for pre-term births at 13.6% (i.e., 45 states are doing better)
* Source: America’s Health Rankings. (2015) Annual Report [Interactive Web Application]. Retrieved from
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

4. Cost
LARC implants and devices are a safe and effective option for reducing unplanned pregnancies
Cost/IUD $647-$930/5 years
Cost /BCPs $3,381/5 years
Post-partum LARC insertion saves approximately $280,000/1000 women over 2 years (vs. unintended pregnancies)

5. Jacksonville LARC Quality Pilot ORGANIZATIONAL ROLES
Agency for Health Care Administration
The Agency for Health Care Administration will work to engage Medical Managed Assistance (MMA) health plans, address barriers to LARCs in collaboration with plans, provide operational oversight and tracking of the LARC Quality Initiative (QI), and facilitate steering committee calls and or webinars with interested stakeholders and key partners.
UF Health
UF Health (i.e., Jacksonville/JAX group) will work to conduct an immediate post-partum pilot initiative at UF Health Shands Hospital; build internal and external administrative support and infrastructure, develop delivery process for device insertions among health care staff, train and educate, and inform consumers.
Florida MMA Health Plans
Florida MMA health plans will work to establish billing and reimbursement methodologies, contract with hospitals, and assess system readiness prior to the LARC pilot to facilitate a smooth statewide implementation.
**United Healthcare has led the pilot from a payer perspective.
Florida Perinatal Quality Collaborative
FPQC Work Group will engage stakeholders in the planning, design, implementation and evaluation of data-driven processes for the LARC QI Projects; and facilitate the statewide roll out.

6. Challenges Education and training Perceived coercion/consent
Stocking and supply
Pay streams
Service location
Data and surveillance

7. Internal and External Champions
Facility - MD/Pharmacy/Billing/maternity floor staff
AHCA
Payer
LARC suppliers
Community - FPQC/Magnolia Project/Medical Society/March of Dimes/ ASTHO (Association for State and Territorial Health Officials)

8. ASTHO (Assn of State & Territorial Health Officials ) LARC Learning Community
Learning Community Purpose:
Improving access to LARC for states
Facilitating state level policy changes and operationalizing the logistics associated with providing access to the most effective contraception available
Providing support in technical assistance (TA) needs and promising practices to assist state leaders in addressing access to highly effective contraception.
Learning Community Goals:
Provide state peer-to-peer exchange and federal agency guidance in technical assistance areas
Reimburse providers or health systems for the cost of providing the full range of contraceptive services, actual cost of LARC and other contraceptive devices, and immediate postpartum insertion of LARC
Remove administrative and logistical barriers

9. Lessons Learned
Strategies need to take into account cultural differences
Payment structures matter – creating incentives and disincentives that impact outcomes
Internal health plan processes and systems can create barriers
Identifying strategies that work and sharing best practices is important component to improving outcomes for all
* Source: America’s Health Rankings. (2015) Annual Report. Retrieved from
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.