THE MATERNAL AND INFANT HEALTH INITIATIVE CONTRACEPTIVE CARE - PowerPoint PPT Presentation

THE MATERNAL AND INFANT HEALTH INITIATIVE CONTRACEPTIVE CARE MEASURES 2019 Update / Closeout Office of Population Affairs/Centers for Disease Control and Prevention Susannah Cohen, Ph.D., M.S. California Department of Health Care Services Information Management Division Office of Family Planning July 18, 2019

Maternal and Infant Health Care Quality • Nearly 2/3 adult women enrolled in Medicaid are in their reproductive years (ages 19-44) • Medicaid currently finances about 45% of all births in the United States • The Centers for Medicare & Medicaid Services (CMS) can play a major role in improving the quality of maternity care, birth outcomes and in measuring how care is delivered to pregnant and postpartum women. • New authorities for quality improvement and measurement in the Affordable Care Act created opportunity to improve perinatal outcomes and reduce disparities 8/15/2019 2

Maternal Infant Health Initiative • The initiative is designed to: 1) improve the rate and content of postpartum visits in Medicaid and the Children’s Health Insurance Program (CHIP) 2) increase the number of births that are intended • Promote the use of effective methods of contraception in order to improve pregnancy timing and spacing and the health outcomes for both women and children. 8/15/2019 3

Adult Medicaid Quality Grants: Measuring and Improving the Quality of Care in Medicaid • Maternal Infant Health Initiative (MIHI) • 4 year grant program (9/2015-9/2019) • 14 states and 1 territory participating • Offered by the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), and Children’s Health Insurance Program (CHIP) 8/15/2019 4

Goals • Testing and evaluating methods for collection and reporting of the Contraceptive Use (CCW) and Postpartum Contraceptive Use (CCP) measures • Developing staff capacity to report, analyze, and use the data for monitoring and improving access and the quality of care in Medicaid • Improve health care quality for women of childbearing age enrolled in Medicaid 8/15/2019 5

CCW : Measure Specifications • Women Age: 15–44 (as of end of measurement year) that: – Adopted or continued use of the most effective or moderately effective FDA-approved methods of contraception. – Adopted or continued use of a long-acting reversible method of contraception (LARC). • Age Groups: – 15–20 and 21–44 8/15/2019 6

CCW: Most/Moderately Effective Contraception Use • Intermediate outcome measure – Measure designed to encourage providers to screen all women for pregnancy intention, and to counsel more fully about contraceptive options so that more women use the most and moderately effective methods of contraception 8/15/2019 7

CCW: LARC Contraception Use • Access measure • Designed to encourage providers/service sites that are under performing (below the mean or median) to focus on removing unnecessary barriers to LARC access 8/15/2019 8

CCW: Eligible Population • Continuous enrollment: • Medi-Cal: Fee-for-Service & Managed Care • The measurement year • FPACT clients • Enrolled at some point during the measurement year • Allowable Gap: • Medi-Cal: No allowable gap during the continuous enrollment period • FPACT: gap allowed, since only need to enroll once per year • Anchor date: December 31 st of measurement year • Benefit: Medical or Family Planning Only Services • Event / dx: Provision of contraception 8/15/2019 9

Measure Definitions • Most effective method of contraception – female sterilization, contraceptive implants , or intrauterine devices or systems (IUD/IUS) • Moderately effective method of contraception – Injectables, oral pills, patch, ring, or diaphragm • Long-acting reversible method of contraception (LARC) – Contraceptive implants, intrauterine devices or systems (IUD/IUS) • Measurement year: Calendar year 8/15/2019 10

Exclusions • Excluded if: – Infecund for non-contraceptive reasons – Pregnant and not at risk of unintended pregnancy – Gave birth in Nov or Dec of measurement year • ACOG guidance is certain contraception can be started 6 weeks after live birth 8/15/2019 11

How Numerators Populations Relates to Eligible Population LARC MM Effective Eligible Women 8/15/2019 12

Total MC FPACT 15-20 Year olds 21-44 Year olds FFS CCW: CA State Eligible Women by Program & Age Group 2014-2017 15-20 Year olds 21-44 Year olds 2014 2015 2016 2017 2014 2015 2016 2017 FFS 17,432 20,817 18,898 16,245 53,505 103,275 72,588 69,610 FPACT 231,214 191,851 188,691 184,448 1,337,285 1,046,242 987,718 949,701 MC 306,889 370,507 425,596 474,854 743,152 1,150,964 1,343,609 1,480,662 Total 555,535 583,175 633,185 675,547 2,133,942 2,300,481 2,403,915 2,499,973 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 8/15/2019 13 2017 Date Downloaded: 01/09/2019

CCW: CA State Eligible Women by Program & Age Group 2014-2017 FFS FPACT 3,000,000 MC # Eligible Women 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 2014 2015 2016 2017 2014 2015 2016 2017 15-20 Year olds 21-44 year olds Program Type, Year, Age Group Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: 01/09/2019 8/15/2019 14

CCW: CA State M/M & LARC Contraceptive Use 2014-2017 # Eligible Age group Year women # MM usage # LARC usage 15-20 2014 555,533 219,606 48,857 15-20 2015 583,175 163,860 28,319 15-20 2016 633,185 172,934 27,019 15-20 2017 675,547 151,678 39,078 Age group 2014 2,133,940 786,705 141,090 21-44 2015 2,300,481 776,030 178,661 21-44 2016 2,403,915 783,239 168,552 21-44 2017 2,499,973 699,257 208,994 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 8/15/2019 15 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Rates of CA State M/M & LARC Contraceptive Use 2014-2017 45% 2014 40% Rate of Contraceptive Use 40% 37% 2015 34% 35% 33% 2016 27% 28% 28% 30% 2017 25% 22% 20% 15% 9% 8% 8% 10% 7% 7% 6% 5% 4% 5% 0% 15-20 years 15-20 years 21-44 years 21-44 years Most/Mod LARC Most/Mod LARC Contraceptive Use Type & Age Group Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 8/15/2019 16 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Last Most / Moderately Effective Contraceptives Provided 2016 & 2017 70% 2016 Contraceptive Type 58% 60% 52% 2017 50% 40% 30% 16% 20% 14% 12% 11% 4% 8% 6% 4% 2% 10% 4% 0% 3% 2% 1% 0% 3% 0% Percent of Total Last Contraceptive Provided Data Source: MIS/DSS data warehouse - Data Represented: 2016-2017 8/15/2019 17 2017 Date Downloaded: 06/24/2019

CCW: CA State M/M & LARC Use by Program & Year Ages 15-20 Years # Eligible # MM # LARC Program Year women usage usage FFS 2014 17,430 8,120 1,673 FFS 2015 20,817 2,688 550 FFS 2016 18,898 2,269 363 FFS 2017 16,245 1,907 495 231,214 62,950 14,739 FPACT 2014 FPACT 2015 191,851 108,128 18,454 FPACT 2016 188,691 110,594 17,344 FPACT 2017 184,448 84,955 23,830 306,889 148,536 32,445 MC 2014 MC 2015 370,507 53,044 9,315 MC 2016 425,596 60,071 9,312 MC 2017 474,854 64,816 14,753 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 6/27/2019 18 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Rates of Contraceptive Use by Program & Contraceptive Type 15-20 years 2014-2017 70% 2014 Rate of Contraceptive Use 2015 59% 60% 56% 2016 48% 47% 50% 46% 2017 40% 27% 30% 14% 13% 13% 20% 14% 14% 10% 12% 12% 11% 10% 3% 9% 6% 10% 3% 3% 3% 2% 2% 0% FFS FPACT MC FFS FPACT MC M/M LARC Program, Contraceptive Type, Year Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 6/27/2019 19

CCW: CA State M/M & LARC Use by Program & Year Ages 21-44 Years # Eligible # MM # LARC Program Year women usage usage FFS 2014 53,503 26,989 4,645 FFS 2015 103,275 15,815 4,419 FFS 2016 72,588 9,519 2,292 FFS 2017 69,910 8,337 2,394 FPACT 2014 1,337,285 385,404 70,887 FPACT 2015 1,046,242 504,388 111,266 FPACT 2016 987,718 469,657 94,732 FPACT 2017 949,701 371,096 113,277 65,558 MC 2014 743,152 374,312 MC 2015 1,150,964 255,827 62,976 MC 2016 1,343,609 304,063 71,528 MC 2017 1,480,662 319,814 93,322 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 8/15/2019 20 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Rates of Contraceptive Use by Program & Contraceptive Type 21-44 years 2014-2017 60% 2014 Rate of Contraceptive Use 50% 50% 2015 48% 48% 50% 2016 39% 2017 40% 29% 23% 30% 22% 15% 22% 20% 13% 11% 12% 9% 12% 9% 6% 10% 4% 10% 5% 3% 5% 5% 3% 0% FFS FPACT MC FFS FPACT MC M/M LARC Program, Contraceptive Type, Year Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 8/15/2019 21 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019