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MICHIGAN CONTRACEPTIVE ACCESS LEARNING COLLABORATIVE: HOW FAR HAVE WE COME?
WHERE DO WE GO NEXT?2018 FAMILY PLANNING UPDATE
SEPTEMBER 13, 2018
PRESENTERS
Jessica Hamel
− Michigan Department of Health & Human Services
Connie Kross
− Ottawa County Department of Public Health
Paulette Bagnall
− Macomb County Health Department
Kristi Villalobos
− Tuscola County Health Department
CONTRACEPTIVE ACCESS LEARNING COLLABORATIVE PRIMARY OBJECTIVE
Support local agencies to facilitate the achievement of their performance goals on two National Quality Forum-endorsed contraceptive measures ─ Intermediate Outcome Measure: % of women aged 15-44 years at risk of
unintended pregnancy that is provided a most effective (i.e., sterilization, implants, IUD/IUS) or moderately effective (i.e., injectables, pills, path, ring, or diaphragm) FDA-approved methods of contraception.
─ Contraceptive Access Measure: % of women aged15-44 years at risk of unintended pregnancy that is provided a long-acting reversible method of contraception(i.e., implants, IUD/IUS).
CONTRACEPTIVE ACCESS LEARNING COLLABORATIVE SECONDARY OBJECTIVE
Increase staff capacity to conduct quality improvement (QI)
Foster collaboration between MDHHS and local Title X-funded agencies
Foster collaboration between Title X-funded agencies
Explore how MDHHS can support QI efforts of local Title X-funded agencies
BREAKTHROUGH SERIES LEARNING COLLABORATION MODEL
Participants(6 Teams)
Pre-Work
Learning Session 1
Learning Session 2
Learning Session 3
Action Period 1
Action Period 1
Action Period 1
May-October 2018 Monthly Virtual Sessions
April 20, 2018In-Person Launch
Holding on Gains
6 to 18 Months Time Frame
Dissemination
CHANGE PACKAGE
1. Stock a broad range of methods.
2. Discuss pregnancy intention and support patients through evidence-informed, patient-centered counseling.
3. Develop systems for same-visit provision of all methods, at all visit types.
4. Utilize diverse payment options to reduce cost as a barrier for the facility and the patient.
BEST PRACTICE #1
Stock a broad-range of methods including all provider-dependent FDA-approved methods
Strategies
Stock a broad-range of FDA-approved methods on-site including all provider–dependent methods
Inform patients of EC
Optimize inventory system
Obtain lower cost supplies
Discuss pregnancy intention and support patients through evidence-informed, patient-centered counseling
Strategies Discuss pregnancy intention
routinely with all patients of reproductive age
If pregnancy is not desired in next year, counsel according to QFP guidelines
Ensure all staff with patient contact are aware of and trained in current recommendations
BEST PRACTICE #2
Develop systems for same-visit provision of all contraceptive methods, including LARC methods*
Strategies
Remove unnecessary barriers such as examinations and tests
Offer Quick Start for all methods
Offer EC when appropriate
Support immediate/same-visit access*Provided that you can be reasonably sure that the patient is not pregnant
BEST PRACTICE #3
Utilize diverse payment options to reduce cost as a barrier for the facility and the patient
Strategies
Ensure organizational policy is in line with Title X program requirements
Obtain third party reimbursement
Provide insurance eligibility screening and application assistance
Optimize billing and coding, revenue cycle management, and patient fee collection protocols
BEST PRACTICE #4
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?
MODEL FOR IMPROVEMENT
PLAN to test your change. DO try carrying out the change. STUDY the test to see if it worked. ACT based on your measured results.
PDSA SCALE UP
Learn from one cycle and apply those findings to the next.
WHAT DO YOU WANT TO ACCOMPLISH?
WHAT DO YOU WANT TO ACCOMPLISH?
PROPOSED SCHEDULE
MONTH SESSION CONTENT
April 20, 2018, 9:00am – 4:00pm (In Person) Getting Started: QI Action Planning
May 17, 2018, 10:00am – 11:00am ETBest Practice 1. Stock a broad range of contraceptive methods including all provider-dependent FDA-approved contraceptive methods.
June 21, 2018, 1:00pm – 2:00pm ETBest Practice 2. Discuss pregnancy intention and support patients through evidence-informed, patient-centered counseling.
July 19, 2018, 1:00pm – 2:00pm ET Best Practice 3. Develop systems for same-visit provision of all contraceptive methods.
August 16, 2018, 1:00pm – 2:00pm ET Best Practice 4. Utilize diverse payment options to reduce cost as a barrier for the facility and the patient.
September 20, 2018, 1:00pm – 2:00pm ET Address Common Concerns for Providing LARC to Adolescents
October 18, 2018, 10:00am – 11:00am ET Sustaining and Spreading Improvements
MICHIGAN TEAMS
LMAS District Health Department
Tuscola County Health Department
Macomb County Health Department
District Health Department #2
Central Michigan Health Department District Health Department #10
NATIONAL CONTRACEPTIVE ACCESS LEARNING COLLABORATIVE
Ottawa County Department of Public Health
MEASURE TRENDS
96%92%
50%
60%
70%
80%
90%
100%
Oct
-16
Nov
-16
Dec
-16
Jan-
17Fe
b-17
Mar
-17
Apr
-17
May
-17
Jun-
17Ju
l-17
Aug
-17
2%
9%
0%1%2%3%4%5%6%7%8%9%
10%
Oct
-16
Nov
-16
Dec
-16
Jan-
17Fe
b-17
Mar
-17
Apr
-17
May
-17
Jun-
17Ju
l-17
Aug
-17
Most or Moderately Effective (MME) LARC
MOST IMPACTFUL CHANGE
Addition of Nexplanon− Clinical staff trained
− Inventory stocked
Same-day insertion− 2 and counting…
STD testing no longer a requirement prior to insertion
Patient-centered approach to contraception
MEASUREMENT OF CHANGE
LARC methods− 2% to 9%
MME− 96% to 92%
Increase in LARC appointment − 4 a month to 24 a month
Patient satisfaction of their method− 617 patients, 92.3% are satisfied
NEXT STEPS & REMAINING CHALLENGES
OCDPH to increase same-day LARC insertion rates
LARC appointments have high no show rates
SUSTAINING IMPROVEMENTS
Most or Moderately Effective− Baseline Average: 96% (Oct 2016 – Dec 2016)
− Endpoint Average: 92% (Jun 2017 – Aug 2017)
− 12-month Follow-Up Average : 91% (Jun 2018 – Aug 2018)
LARC − Baseline Average: 4% (Oct 2016 – Dec 2016)
− Endpoint Average: 8% (Jun 2017 – Aug 2017)
− 12-month Follow-Up Average: 10% (Jun 2018 – Aug 2018)
MICHIGAN CONTRACEPTIVE ACCESS LEARNING COLLABORATIVE
Macomb County Health Department
MEASURE TRENDS
82%
88%
50%
60%
70%
80%
90%
100%
Oct
-17
Nov
-17
Dec
-17
Jan-
18
Feb-
18
Mar
-18
Apr
-18
May
-18
Jun-
18
Jul-1
83%
9%
0%1%2%3%4%5%6%7%8%9%
10%
Oct
-17
Nov
-17
Dec
-17
Jan-
18Fe
b-18
Mar
-18
Apr
-18
May
-18
Jun-
18Ju
l-18
MME LARC
MOST IMPACTFUL CHANGE
Addition of “Are you highly satisfied with your birth control method?”− Enabled staff to counsel clients on most effective to least effective methods
− Used reproductive life plan to help clarify best method for client
− Used Contraceptive Action Plan Birth Control Chart to help client understand options available
Provision of Nexplanon at all 4 sites increased uptake/availability of this method
MEASUREMENT OF CHANGE
LARC methods− 3% to 9%
MME− 82% to 88%
Increase in LARC placements− 2 per month (10/17) to 10 per month (7/18)
Patient satisfaction of their method− 90% of patients are satisfied with their method
NEXT STEPS & REMAINING CHALLENGES
Continue to push toward same-day on-site IUD insertions at all clinical sites
Continue to supply same-day Nexplanon insertions at all clinical sites
Vigilant follow-up with corporate counsel and Henry Ford Macomb to get contracts approved for pelvic ultrasound and contraceptive emergency services
LESSONS LEARNED
Stay focused on what you are trying to achieve!
Celebrate success and positive change
Quality improvement is a continuous process
MICHIGAN CONTRACEPTIVE ACCESS LEARNING COLLABORATIVE
Tuscola County Health Department
TUSCOLA COUNTY BACKGROUND
Only two hospitals
Zero delivering hospitals
Zero OB/GYN practices
HEALTH DEPARTMENT BACKGROUND
Three Family Planning clinics per month
One out of county contracted provider for LARC
Only stocking Paragard
TUSCOLA’S PERFORMANCE IMPROVEMENT PLAN
Stock additional brands of IUDs
Increase number of in-county contracted providers for LARC
Create LARC referral tracking log
TUSCOLA COUNTY CONTACTS/OUTCOMES
McLaren Caro Region Hospital − One contracted OB/GYN from Flint two to three days per month
− Declined
Hills & Dales General Hospital− No providers insert IUDs
Mayville Family Healthcare (Marlette Hospital Affiliated)− Outcome pending
Expand contracts with surrounding counties − Saginaw− Lapeer− Huron
MOST IMPACTFUL CHANGE
Made community hospitals aware of gaps in service
Tracking log allowed for follow-up contacts to clients
NEXT STEPS
Increase number of out of county contracted providers
New Medical Director buy-in
MEASURE TRENDS
98% 97%
50%
60%
70%
80%
90%
100%
Oct
-17
Nov
-17
Dec
-17
Jan-
18
Feb-
18
Mar
-18
Apr
-18
May
-18
Jun-
18
Jul-1
8
2%
0%0%
1%
1%
2%
2%
3%
Oct
-17
Nov
-17
Dec
-17
Jan-
18
Feb-
18
Mar
-18
Apr
-18
May
-18
Jun-
18
Jul-1
8
MME LARC
QUESTIONS?
Jessica Hamel
517-335-9263
Connie Kross
616-393-5732
Paulette Bagnall
586-469-5491
Kristi Villalobos
989-673-1722
Thank you!
