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Jacksonville Long-acting Reversible Contraception (LARC) Pilot

Addressing the issue of unplanned pregnancies, this pilot program aims to improve access to long-acting reversible contraception (LARC) in Jacksonville, Florida. By providing education, training, and removing barriers, the program aims to reduce health complications and associated costs.

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Jacksonville Long-acting Reversible Contraception (LARC) Pilot

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  1. Jacksonville Long-acting Reversible Contraception (LARC) Pilot Eina G. Fishman, MD, MS, CPE Chief Medical Officer, United HealthCare Florida Plan March 8, 2017

  2. What is the issue? • Unplanned pregnancies are a major challenge • Unplanned pregnancies are associated with delayed prenatal care, premature birth, low-birth weight and other health complications • 64% of infant deaths were related to unplanned pregnancies • 45% of women reported unprotected sex before their post partum check up • Medicaid State programs cover nearly 2/3 unplanned pregnancies (1.7 million births a year), spending over $10 billion dollars on these births annually

  3. Addressing Reproductive Health *Florida Statistics Compared to National Data • Ranked 33rd in the nation for overall health • Ranked 40th in the nation for health disparities (i.e., 39 states are doing better) • Ranked 35th in the nation for low birth rate at 8.5% (i.e., 34 states are doing better) • Ranked 46th in the nation for pre-term births at 13.6% (i.e., 45 states are doing better) * Source: America’s Health Rankings. (2015). 2015 Annual Report [Interactive Web Application]. Retrieved from http://www.americashealthrankings.org/explore/2015-annual-report/measure/birthweight/state/ALL Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  4. Cost • LARC implants and devices are a safe and effective option for reducing unplanned pregnancies • Cost/IUD $647-$930/5 years • Cost /BCPs $3,381/5 years • Post-partum LARC insertion saves approximately $280,000/1000 women over 2 years (vs. unintended pregnancies)

  5. Jacksonville LARC Quality PilotORGANIZATIONAL ROLES

  6. Challenges • Education and training • Perceived coercion/consent • Stocking and supply • Pay streams • Service location • Data and surveillance

  7. Internal and External Champions • Facility - MD/Pharmacy/Billing/maternity floor staff • AHCA • Payer • LARC suppliers • Community - FPQC/Magnolia Project/Medical Society/March of Dimes/ ASTHO (Association for State and Territorial Health Officials)

  8. ASTHO (Assn of State & Territorial Health Officials ) LARC Learning Community • Learning Community Purpose: • Improving access to LARC for states • Facilitating state level policy changes and operationalizing the logistics associated with providing access to the most effective contraception available • Providing support in technical assistance (TA) needs and promising practices to assist state leaders in addressing access to highly effective contraception. • Learning Community Goals: • Provide state peer-to-peer exchange and federal agency guidance in technical assistance areas • Reimburse providers or health systems for the cost of providing the full range of contraceptive services, actual cost of LARC and other contraceptive devices, and immediate postpartum insertion of LARC • Remove administrative and logistical barriers

  9. Lessons Learned • Strategies need to take into account cultural differences • Payment structures matter – creating incentives and disincentives that impact outcomes • Internal health plan processes and systems can create barriers • Identifying strategies that work and sharing best practices is important component to improving outcomes for all * Source: America’s Health Rankings. (2015). 2015 Annual Report. Retrieved from http://www.americashealthrankings.org/explore/2015-annual-report/ Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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