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Washington, DC — Today, Planned Parenthood Federation of America and Manatt Health released a policy paper that helps state policymakers and payers implement contraceptive care quality measures to improve access to all forms of contraception.

The paper, “Measuring Quality Contraceptive Care in a Value-Based System,” serves as a tool for policymakers, detailing how to incorporate contraceptive care quality measures in Value Based Payment (VBP) initiatives to both ensure agency in women’s contraceptive choices and develop strategies to improve people’s access to contraception. 

Statement from Sydney Etheredge, director of Planned Parenthood’s Health Care Investment Program:

“We combined our expertise as one of the nation’s leading providers of reproductive health care with our policy knowledge to develop a unique tool that provides policymakers with guidelines to maximize the effectiveness of measuring contraceptive use, while also ensuring that each individual’s contraceptive preferences and use are respected.”

The tool outlines 5 specific guidelines for Medicaid Managed Care Organizations (MMCO) and other payers to follow when implementing contraceptive care quality measures: 

  1. Leverage pay for reporting models; 

  2. Avoid incorporating contraceptive care quality measures into pay-for-performance models;

  3. Proceed cautiously when using contraceptive care quality measures in shared savings or population-based models; 

  4. Require stratified demographic data against measures; and 

  5. Use additional measures or approaches that are designed to complement contraceptive care quality measures, including patient satisfaction and pregnancy intention.   

The National Quality Forum’s (NQF) endorsement in 2016 of three contraceptive care quality measures was a milestone, providing an evaluation metric on availability and use of effective contraception. The subsequent incorporation of two of the three contraceptive care quality measures by the Centers for Medicare & Medicaid Services (CMS) in 2017 dramatically increased the use and utility of the contraceptive quality care measures and provided a rich source of data. 

This created an opportunity for state policymakers and their MMCOs and provider partners to use the results from the measures to assess the extent to which Medicaid enrollees are receiving contraception, identify geographic areas where there may be barriers impeding access to contraception, and develop strategies to improve access. 

For example, states may use these measures to identify providers with comparatively low long acting reversible contraception (LARC) utilization rates, such as LARC insertion rates of less than 1 or 2 percent and then engage those providers to assess any underlying impediments, such as inadequate training of providers or the cost of stocking LARCs. States could also use information about performance on the postpartum contraceptive measure to ensure access and improve continuity of care during the postpartum period in hospital settings where unique challenges exist to providing contraception.

Given this country’s history of coercive practices related to contraceptive use for low-income women, women of color, and other historically marginalized communities, state policymakers must use care in incorporating contraceptive care quality measures in Value Based Payment (VBP) program incentives. For example, when using contraceptive care quality measures in VBP purchasing arrangements, it is important to ensure that “improvement” is not necessarily or simply equated with higher rates of contraceptive use. Birth control methods are not one-size-fits-all and each patient’s contraceptive use must be respected as a highly personal decision. Any measurement that rewards higher rates of use could inadvertently and unduly influence women’s decisions to use contraception or to use specific types of contraception, such as LARCs.

By combining the careful use of objective measures with qualitative measures presented in the tool, policymakers can assess and improve people’s access to contraception and simultaneously ensure that women’s personal medical decisions are respected.

The Measuring Quality Contraceptive Care in a Value-Based System tool is available to all policymakers and can be accessed HERE

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Planned Parenthood is the nation’s leading provider and advocate of high-quality, affordable health care for women, men, and young people, as well as the nation’s largest provider of sex education. With more than 600 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect and without judgment. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable health information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives. 

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