Dr. Jeffrey D. Howard, Commissioner

Collaboration of Health Systems to Address Family Planning and Women’s Cancer ScreeningConnie Gayle White, MD, FACOG

Senior Deputy Commissioner

Jan ChamnessDirector, Division of Women’s Health

May 17, 2019

Objectives1. Understand the Family Planning and

Kentucky Women’s Cancer Screening Programs at the Department for Public Health (DPH).

2. Discuss the impact of providing reproductive health services to vulnerable populations.

3. Discuss how Federally Qualified Health Centers and look-alike providers can partner with their local health departments or directly with the DPH Division of Women’s Health to increase optimal family spacing, breast and cervical cancer screening and other reproductive health services across Kentucky.

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KY has approximately 284,530 women ages 13-44 in need of publicly funded family planning services.

LHDs and other sub recipients provided FP services to 47,306 clients in CY 2018.

85% of the clients served were 150% below the federalpoverty level

36% of the clients served were uninsured

21% of the clients were ages <15 – 19 (11% were 17 years old or younger)

Breast Cancer Screening:

• CBE• Mammograms

• MRIsFollow-up

Diagnostics

Increased screening rates reduce breast/cervical morbidity/mortality rates!

Saving Women’s Lives Through Early DetectionKentucky Women’s Cancer Screening Program

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Cervical Cancer Screening: • Pap test• HPV testFollow-upDiagnostics

Case Management

Patient Navigation

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Estimated # of uninsured women in KY (KWCSP eligible): 53,7658

Total # of breast cancers in KY (2012-2016): 147,184

Total # of cervical cancers in KY (2012-2016): 1,044

Total # of women screened through KWCSP in FY 2018: 5,565

Total # of KWCSP clients receiving follow-up care in FY 2018: 600

The Impact of Providing Reproductive Health to Vulnerable Populations

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CARLISLE

GRAVES

FULTON

HICKMAN

ROBERTSON

CALLOWAY

ROCKCASTLE

Kentucky Percent of Persons Living in Poverty2017 US Census Estimate

US 14.6% KY 18.3% 5.5 - 15.9

16.0 - 23.423.5 - 34.935.0 - 49.5At least 1 FQHC or look-alike provider in the county providing WH services.

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Cervical & Breast Cancer

Screening-Rarely or never

screened populations

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Being rarely or never screened is the major contributing factor to most cervical and breast cancer deaths.Who are the rarely or never screened?

• Minorities• Low socioeconomic status• Foreign born, living in the U.S. < 10 yrs.• No source of health care

Sources: US Census, BRFSS, National Health Interview Survey, National Center for Health Statistics, CDC

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Partnership with Juniper Health in Lee County

An impressive beginning…

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Baseline breast screening rates:• 62% (September, 2018)

Current breast screening rates:• 73% (January, 2019)

Source: Juniper Health, Inc. data through January 2019.

Patient Navigation Results…

Optimal Family

Spacing

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Helping every client have and maintain a reproductive life plan

Providing a wide variety of effective client-centered contraceptive methods to clients who wish to delay or prevent pregnancy

Benefits:

• Prevent unplanned and potentially unwanted pregnancies

• Healthy maternal and child outcomes• Allows a woman or couple to achieve

goals• Decreases the likelihood of poverty

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Kentucky Teen Birth Rate:Lowest in Recorded History

2008-55.3

2017-28.1

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2008Rate

2011 Rate

2012 Rate

2013 Rate

2014 Rate

2015 Rate

2016Rate

2017Rate*

Kentucky 55.8 43.13 40.5 38.7 34.5 31.4 30 28.1

Appalachian Counties

62.4 54.7 55.2 50.2 46 42.8 41.1 37.7

Non-Appalachian Counties

52.4 38.8 35.8 34.6 30.4 27.3 26.2 24.8

National Rate

41.6 31.3 29.4 26.6 24.2 22.3 20.3 18.8

KY Data Source: KY Vital Statistics *Preliminary Data

Kentucky Teen Birth Trends2008, 2011-2017

Per 1000 females ages 15-19

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(Positive Youth Development-centered)

Family Planning’s Role related to the Substance Abuse Crisis

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2014 2015 2016 2017 2018Acute Drug Poisoning (overdose) Any Substance

13,934 16,428 18,841 19,975 16,795

Drug Dependence(excluding overdoses)Any Substance

15,309 17,678 20,682 22,700 22,390

Nondependent Abuse of Drugs (excluding overdoses) Any Substance

38,152 44,038 47,388 53,551 59,970

Drug-related Hospitalizations & ER Visits among KY Residents (Source: KIPRC)

Family Planning’s Role related to the Substance Abuse Crisis

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In 2014*, nearly2 out of every 100

women giving birth in Kentucky was diagnosed with Opioid Use Disorder.

*Most recent available data (Source: 2019 DPH NAS Report)

63%

Number of substances

Frequency of Polysubstance Use

Contraceptive Methods

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Contraceptive methods are tiered from most effective to least effective based on failure rates. Failure rates are directly related to a person’s involvement in using the method.

Less than 1 pregnancy per 100 women in a year

6-12 pregnancies per 100 women in a year

Contraceptive Methods

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Contraceptive methods are tiered from most effective to least effective based on failure rates. Failure rates are directly related to a person’s involvement in using the method.

18 or more pregnancies per 100 women in a year

Client choice is very important. What works for one client will not work for others. Clients need education and empowerment to make the right decision for them.

Potential Partnerships to Increase Women’s Health Services Across Kentucky

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KENTUCKY PUBLIC HEALTHTRANSFORMATION

Working together for an efficient, sustainable and accountable public health system focused on producing

better health outcomes for all Kentuckians.

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HOW DID LOCAL HEALTH DEPARTMENTS GET HERE?

Several factors have influenced this transformation but most impactful are:

1.Affordable Care Act

2.Kentucky’s pension crisis

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Fiscal Instability1CHALLENGES

LHD services are not reflective of community needs2 • Many LHD are duplicating services already provided by

FQHCs and other agencies in their community

• Decreased state and federal funding• Decreased number of uninsured population

requiring services• Pension costs

3• Current statutes and regulations

are not in line with current public health landscape

• Hybrid structure of public health (state and local governance)

Legislative Issues and Shared Governance

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Fiscal Instability1Solutions

LHD services are not reflective of community needs2 Seek partnerships with FQHCs and other agencies who are

providing the services to eliminate duplication.

3• Collaboration, transparency and

trust at all levels and with community partners.

• Education and accountability with LBOH and community partners.

Legislative Issues and Shared Governance

Simplify and focus PH model, prevent duplication, share resources and expertise.

Partnering with the Division of Women’s Health (DWH)

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To date: 27 LHDs representing 47 counties will not be accepting federal funds to provide most women’s health services in FY 2020.

21 LHDs are yet to notify DWH of their intentions.

Partnering with the Division of Women’s Health

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The DWH anticipates partnering with FQHCs or look-alike providers in counties where LHDs have declined federal funds .

Conversations and preliminary negotiations are in process with seven FQHCs or look-alike providers.

Partnering with the Division of Women’s Health

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Partnerships may include:•Federal funding for women’s cancer screening and family planning services for uninsured/underinsured clients

•Patient outreach and navigation services for women’s cancer screening

Agreements are personalized to the service needs of the communities and ability to provide services

Partnering with the Division of Women’s Health

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Benita Decker, RNFamily Planning/

Adolescent Health Program DirectorDPH, Division of Women’s Health

502-564-3236 X4169

Ellen BarnardKWCSP Program Director

DPH, Division of Women’s Health

502-564-3236 X4157

Jan ChamnessDirector

DPH, Division of Women’s Health

502-564-3236 X4065

Connie Gayle White, MD, FACOGSenior Deputy CommissionerDepartment for Public Health

502-564-3970 X4062