Collaboration of Health Systems to Address Family Planning and Women’s Cancer Screening Connie Gayle White, MD, FACOG Senior Deputy Commissioner Jan Chamness Director, Division of Women’s Health May 17, 2019 Dr. Jeffrey D. Howard, Commissioner
Objectives 1. 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 federal poverty level 36% of the clients served were uninsured 21% of the clients were ages <15 – 19 (11% were 17 years old or younger) 4
Kentucky Women’s Cancer Screening Program Saving Women’s Lives Through Early Detection Breast Cancer Cervical Cancer Case Screening: Screening: Management • CBE • Pap test • Mammograms • HPV test • MRIs Patient Follow-up Navigation Follow-up Diagnostics Diagnostics Increased screening rates reduce breast/cervical morbidity/mortality rates! 5
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 6
The Impact of Providing Reproductive Health to Vulnerable Populations 7
Kentucky Percent of Persons Living in Poverty 2017 US Census Estimate US 14.6% KY 18.3% 5.5 - 15.9 16.0 - 23.4 ROBERTSON 23.5 - 34.9 35.0 - 49.5 At least 1 FQHC or look-alike provider in the county providing WH services. ROCKCASTLE CARLISLE GRAVES HICKMAN CALLOWAY FULTON
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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? Cervical & • Breast Cancer Minorities • Low socioeconomic status Screening- • Foreign born, living in the U.S. < 10 yrs. Rarely or never • No source of health care screened populations Sources: US Census, BRFSS, National Health 11 Interview Survey, National Center for Health Statistics, CDC
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Partnership with Juniper Health in Lee County An impressive beginning… Patient Navigation Results… Baseline breast screening rates : • 62% (September, 2018) Current breast screening rates: • 73% (January, 2019) 13 Source: Juniper Health, Inc. data through January 2019 .
Helping every client have and maintain a reproductive life plan Providing a wide variety of effective Optimal client-centered contraceptive methods to Family clients who wish to delay or prevent pregnancy Spacing Benefits: • Prevent unplanned and potentially unwanted pregnancies • Healthy maternal and child outcomes • Allows a woman or couple to achieve goals 14 • Decreases the likelihood of poverty
Kentucky Teen Birth Rate: Lowest in Recorded History 2008- 55.3 2017- 28.1 15
Kentucky Teen Birth Trends 2008, 2011-2017 Per 1000 females ages 15-19 2008 2011 2012 2013 2014 2015 2016 2017 Rate Rate Rate Rate Rate Rate Rate Rate* Kentucky 55.8 43.13 40.5 38.7 34.5 31.4 30 28.1 Appalachian 62.4 54.7 55.2 50.2 46 42.8 41.1 37.7 Counties Non- Appalachian 52.4 38.8 35.8 34.6 30.4 27.3 26.2 24.8 Counties National 41.6 31.3 29.4 26.6 24.2 22.3 20.3 18.8 Rate KY Data Source: KY Vital Statistics *Preliminary Data 16
(Positive Youth Development-centered) 17
Family Planning’s Role related to the Substance Abuse Crisis Drug-related Hospitalizations & ER Visits among KY Residents (Source: KIPRC) 2014 2015 2016 2017 2018 Acute Drug Poisoning (overdose) 13,934 16,428 18,841 19,975 16,795 Any Substance Drug Dependence (excluding overdoses) 15,309 17,678 20,682 22,700 22,390 Any Substance Nondependent Abuse of Drugs (excluding 38,152 44,038 47,388 53,551 59,970 overdoses) Any Substance 18
Family Planning’s Role related to the Substance Abuse Crisis In 2014*, nearly 2 out of every 100 women giving birth in Kentucky was diagnosed with Opioid Use Disorder. Frequency of Polysubstance Use Number of substances *Most recent available data (Source: 2019 DPH NAS Report) 63% 19
Contraceptive Methods 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 20
Contraceptive Methods 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. 21
Potential Partnerships to Increase Women’s Health Services Across Kentucky 22
KENTUCKY PUBLIC HEALTH TRANSFORMATION Working together for an efficient, sustainable and accountable public health system focused on producing better health outcomes for all Kentuckians. 23
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 24
CHALLENGES • Decreased state and federal funding 1 • Decreased number of uninsured population Fiscal Instability requiring services • Pension costs LHD services are not reflective of community 2 • Many LHD are duplicating services already provided by needs FQHCs and other agencies in their community • Current statutes and regulations Legislative Issues and are not in line with current public 3 health landscape Shared Governance • Hybrid structure of public health (state and local governance) 25
Solutions 1 Simplify and focus PH model, prevent Fiscal Instability duplication, share resources and expertise. LHD services are not reflective of community 2 Seek partnerships with FQHCs and other agencies who are needs providing the services to eliminate duplication. • Collaboration, transparency and Legislative Issues and trust at all levels and with 3 community partners. Shared Governance • Education and accountability with LBOH and community partners. 26
To date: 27 LHDs representing 47 counties will not be Partnering with accepting federal funds the Division of to provide most women’s Women’s health services in FY Health (DWH) 2020. 21 LHDs are yet to notify DWH of 27 their intentions.
The DWH anticipates partnering with FQHCs or look-alike providers in Partnering with counties where LHDs have the Division of declined federal funds . Women’s Health Conversations and preliminary negotiations are in process with seven FQHCs or look-alike providers. 28
Partnerships may include: • Federal funding for women’s cancer screening and family planning services for Partnering with uninsured/underinsured the Division of clients Women’s • Patient outreach and Health navigation services for women’s cancer screening Agreements are personalized to the service needs of the communities and ability to provide services 29
Partnering with the Division of Women’s Health 30
Jan Chamness Connie Gayle White, MD, FACOG Director Senior Deputy Commissioner DPH, Division of Women’s Health Department for Public Health 502-564-3236 X4065 502-564-3970 X4062 Ellen Barnard Benita Decker, RN KWCSP Program Director Family Planning/ DPH, Division of Women’s Health Adolescent Health Program Director DPH, Division of Women’s Health 502-564-3236 X4157 502-564-3236 X4169 31
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