ASTHO LARC Learning Community Virtual Learning Session Outreach. December 17, :00-4:00p ET , ext. #

Transcription

1 ASTHO LARC Learning Community Virtual Learning Session Outreach December 17, :00-4:00p ET , ext. #

2 Agenda 2:00 Welcome and Introductions 2:15 White Bagging State Discussion 2:35 How to Reach Women and Increase Their Positive Regard for the Most Effective Methods of Contraception 2:50 G-Power App for Teens 3:05 Outreach Discussion 3:20 News on IUD Coding: Update and Discussion 3:30 Group State Reports: Progress on State Action Plans 3:50 Key Informant Interviews 3:57 Key Themes and Next Steps 4:00 Adjourn

3 Webinar Objectives Discuss state successes and challenges with strategies for provider payment (e.g. white bagging) Examine teen outreach and marketing strategies and how they can be adapted for immediate postpartum LARC Review coding changes for Liletta devices Learn about recent actions of LARC Learning Community states since the October 19-20, 2015, in person meeting

4 Welcome and Introductions Welcome from ASTHO Lisa Waddell, MD, MPH Community Health and Prevention Chief

5 State Team Introductions MT CO IA IN DE MD MA NM TX OK LA SC GA LARC Learning Community Cohort 1 States LARC Learning Community Cohort 2 States

6 White Bagging LARC Devices: How It s Working / How It s Not Discussion

7 Payment for Devices with Health Insurance Hospital orders the LARC and is responsible for stocking Physician inserts the LARC and bills for the insertion Hospital bills Medicaid for the device to be paid in full outside the DRG

8 White Bagging or Specialty Pharmacy* Provider calls Medicaid/specialty pharmacies LARC is charged to patient s Medicaid ID number. Device is shipped overnight to the office 30 days to insert the LARC Opportunity for patient outreach Device is returned to the pharmacy if the patient does not show or changes their mind Device fee is credited to the patient s Medicaid *Outpatient

9 Buy and Bill or Pharmacy Medical Benefit* Provider orders devices out of pocket Devices are shipped directly to the practice Upon insertion, the provider bills patient s insurance for the device and insertion Reimbursement for the device is contingent on patient demand Challenges: Over/under ordering devices *Outpatient

10 White Bagging LARC Devices: How it s Working / How it s Not Discussion

11 How to Reach Women and Increase Their Positive Regard for the Most Effective Methods of Contraception Katherine Suellentrop, MPH Senior Director, State Support The National Campaign to Prevent Teen and Unplanned Pregnancy

12 WHOOPS PROOF BIRTH CONTROL How to Reach Women and Increase Their Positive Regard for the Most Effective Methods of Contraception THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 12

13 PROJECT GOALS To increase the number of women who choose IUDs and the Implant as their method of contraception, The National Campaign set out to: Reposition IUDs and the Implant in a relevant and meaningful way through messages and ideas. Develop a framework for a public, consumer-facing communications campaign to increase positive regard for these methods. THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 13

14 OUR APPROACH Our approach was firmly rooted in the views, feelings, experiences, and words of these young women and included: A review of relevant research and reports. Expert interviews with health care practitioners, media experts and those who provide sex and relationship advice to young adults. Deep qualitative research and iterative design process with 70 women in New York City, Indianapolis, San Antonio, Atlanta and South Carolina. THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 14

15 9 KEY INSIGHTS & APPLICATIONS THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 15

16 INSIGHT #1 Most women are unaware of the wide range of birth control options out there. WHAT WE HEARD Initially it wasn t really a choice in high school, they were saying use condoms or don t have sex When that wasn t really working for me, I went to the doctor and he was like use a low dose pill. And that didn t work, so I stopped... THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 16

17 INSIGHT #2 Effectiveness is expected. WHAT WE HEARD I kind of feel like most of the birth controls are over 90% effective. Why would a clinic offer a method if it isn t effective? THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 17

18 INSIGHT #3 Side effects can be more important to young women than effectiveness. WHAT WE HEARD When I was on birth control, I was breaking out. Having those body changes really messes with your self-esteem generally. Oh and I m doing this for sex sacrificing how I look for sex?! It may be effective, but do [other women] like it? Did they stop using it for a reason? THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 18

19 INSIGHT #4 The concept of long-acting as a desirable attribute of IUDs and the Implant does not resonate with young women. WHAT WE HEARD If I m not in a long-term relationship, why should I have a long-acting method of birth control? I don t like this one [ad] because it calls out a 3 year plan. What if I don t have a 3 year plan? What if I don t have a tomorrow plan? What if I don t know what I m doing this weekend?! THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 19

20 INSIGHT #5 Women confuse IUDs and the Implant, but there are differences and strong personal preferences attached to each. I thought an implant was a general term for an IUD. Isn t an IUD implanted? IED WHAT WE HEARD THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 20

21 INSIGHT #6 Communicating how it will feel for both women and their partners is vital. WHAT WE HEARD What the doctor tells you is clinical, but not how it feels. We both can t feel it, that s a main concern for me. I don t want him to feel it either because I know how he is. I know how a really bad cramp feels [using familiar comparisons] is going to make me feel that much more comfortable. THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 21

22 INSIGHT #7 Women want to hear from other women. WHAT WE HEARD Before I got an IUD, I was searching for women who had one. I look it up and then go to the doctor and say well, people are saying this, what is your opinion? This [ad] is almost like a review. I look for reviews for everything. THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 22

23 INSIGHT #8 Birth control is a journey full of troubleshooting. WHAT WE HEARD I don t think women are learning about birth control. They just want to find something that works. When they do research, it s because something is not working. THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 23

24 RECAP THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 24

25 9 WAYS TO SHIFT THE CONVERSATION Offer IUDs and the Implant first informing young women of these most effective methods, without overwhelming them with the wide array of options all at once. Emphasize not only effectiveness, but more importantly, other attributes and benefits of IUDs and the Implant. Explain how IUDs and the Implant are made to work with young women s bodies by highlighting both low and no hormone IUD options, and the hormonal benefits associated with the Implant Describe IUDs and the Implant as low maintenance methods made to fit this now generation of young women vs. using the term LARCs. Highlight the distinct attributes, placement, and benefits of IUDs and the Implant individually to guide women at pivotal points in their decision making process. Engage women in an honest conversation about how it will feel during the entire experience for both themselves and their partners. 7 Share experiences that other women have had with these methods the good and the bad using everyday language to provide them with the confidence and comfort they re seeking. 8 Frame the birth control conversation around what matters most to each individual woman s needs, concerns and preferences from side effects to adherence issues. THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 25

26 THANK YOU THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 26

27 G-Power App for Young People Kim M. Nolte, MPH, MCHES President and CEO Georgia Campaign for Adolescent Power and Potential (GCAPP)

28 THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 28

29 FREE Cell Phone App for Young People Young people need to know their rights to sexual health services to know what types of methods are available and most effective to know where to access these services to have a voice in sharing knowledge and improving services THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 29

30 Power in the Palm of Your Hand What to Know Minor s Rights Contraceptive Methods What to Expect What to Ask THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 30

31 Link to over 200 Title X clinics and condom locations in GA Where to Go GPS Turn by Turn directions 1 click to call the clinic THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 31

32 Real Talk Videos LARC Contraceptives Male Condom Demo Female Condom Demo THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 32

33 Friendly Reminder Set up Birth Control Reminder Set up Dr. Appointment reminder THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 33

34 Giving Youth a Voice Speak Up Rate the clinics Share app with Friends Provide feedback to improve the app THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 34

35 Download now! Search gpower THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 35

36 Help Spread the Word!! Posters Palm Cards Ask Young People to Rate your Service THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY 36

37 Outreach Participant Discussion Questions and Discussion

38 Liletta Coding Update and Discussion Amanda Kelinson, MPA Manager, Health Care Delivery National Family Planning and Reproductive Health Association (NFPRHA)

39 News on IUD Coding

40 November 2015 May 2014 Bayer requests CMS change J7302 description to include Mirena April 2015 Medicines360 introduces Liletta to market Liletta assigned J7302 by CMS May 2015 Bayer again requests change to J7302 description Also requests CMS assign temporary code to Liletta CMS issues final ruling that J7302 is discontinued Replaces J7302 with two separate codes for the two devices CMS denies request

41 Effective January 1, 2016 HCPCS Long Description Short Description Brand Name J7297 Levonorgestrel-releasing intrauterine contraceptive system, 52mg, 3 year duration Levonorgestrel iu 52mg 3 yr Liletta J7298 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 5 year duration Levonorgestrel iu 52mg 5 yr Mirena NO MORE J7302

42 Liletta Coding Update and Discussion Questions?

43 State Reports: Progress on State Action Plans

44 State Reports: Progress on State Action Plans Highlights from all states Georgia, Louisiana, and Montana will present for 2-3 minutes Following state updates, time will be allotted for questions or reactions.

45 State Reports: Training CO: Planning LARC symposium on June 6-7 with 3 training tracks for 150 providers and administrators SC: Launched the LARC Postpartum Toolkit ( at the 2015 SC Birth Outcomes Initiative symposium with 350 participants from 9 states

46 State Reports: Outreach and Partnerships Outreach IA: Using tear-off sheets and infographics to help providers inform patients about IUDs and implants. Partnerships IN: Indiana Perinatal Quality Improvement Collaborative (IPQIC) All Subcommittee Co-Chairs meeting about the LARC Learning Community and opportunities for collaboration

47 State Reports: Reimbursement & Sustainability DE: Arranging a MOU with Christiana Health Care Services to provide a small amount of funds to support a pilot evaluation project. MA: Working with the Division of Insurance to review internal surveys on commercial insurance coverage for contraception under ACA. OK: Obtained private funding for a 2-year program with 2 dedicated staff members to address reducing unwanted pregnancies through LARC.

48 State Reports: Measurement, Data, and Evaluation and Service Location Measurement, Data, and Evaluation MD: Interviewing billing and pharmacy staff with the highest numbers of Medicaid Births to collect information on common barriers and potential solutions TX: Establishing baseline data for IPP LARC Service Location NM: Planning a IPP LARC Protocol pilot in Lea County (2 nd highest teen birth rate in state) by seeking out prenatal care providers.

49 State Reports: Progress on State Action Plans Georgia Louisiana Montana

50 GEORGIA Key Action Steps: Begun conversations with the Georgia Hospital Association on facilitation of IPP LARCs Working with Care Management Organizations on billing logistics for IPP LARCs by hospital staff Recruiting birthing hospitals to join perinatal quality collaborative addressing IPP LARC implementation

51 Louisiana Key Action Steps: LARC Presentation with Medicaid MCO case managers and stakeholders on November 19, 2015 (>100 participants). Substantial LARC data requests submitted to our OPH & Medicaid epi. analysts in an effort to gain a deeper understanding of LARC utilization. Results will drive future outreach efforts. LARC IPP hospital outreach strategy in draft stages includes regional identification of clinical champions and residency training programs. OPH & Medicaid are working on LARC FQHC & RHC payment model policy changes to carve out cost of the devices.

52 Montana Key Action Steps: Statewide Provider Training Planning is just beginning regarding provider trainings in Looking at ways to provide both provider training and billing training for hospitals. Currently determining what type of training is needed in each facility. Unbundling of Postpartum LARC payment for Indian Health Service Hospitals paid by Medicaid Montana has 1 IHS Hospital that performs deliveries. Discussions with Medicaid administration has begun to determine if unbundling postpartum LARCs is a possibility for IHS facilities. Due to the way IHS facilities are paid for inpatient stays and medications are received this may not be needed for these facilities.

53 Next Steps for Key Informant Interviews Kristin Rankin, PhD Assistant Professor Division of Epidemiology and Biostatistics University of Illinois at Chicago School of Public Health

54 Evaluating the Implementation of IPP LARC in ASTHO Learning Community States - Update Kristin Rankin, PhD Assistant Professor Carla DeSisto, MPH Doctoral Student in MCH Epidemiology Division of Epidemiology and Biostatistics and Center of Excellence in Maternal and Child Health School of Public Health University of Illinois at Chicago

55 Completed Evaluation Activities Participation and Observation at Learning Community Meetings Kick-off meeting Key Informant Interviews Cohort 2 (Nov-Dec 2015) Sharing TA needs with ASTHO as they come up. Thank you Cohort 2 Teams for your time and insights!

56 Planned Evaluation Activities Participation and Observation at Learning Community Meetings Web-based Sharing and Learning Sessions Key Informant Interviews Cohort 1 (Jan-Feb 2016) Team Self-Evaluation Development Cohorts 1 & 2 (~Spring/Summer 2016)

57 Planned Evaluation Products Written reports from key informant interviews and self-evaluation Contribution to the documentation of implementation strategies employed across states Scientific meeting abstracts and peer reviewed journal submissions

58 Questions/Suggestions? Kristin Rankin, PhD

59 Closing Charlan D. Kroelinger, PhD Team Leader Maternal and Child Health Epidemiology Program Field Support Branch Division of Reproductive Health Centers for Disease Control and Prevention

60 Next Steps Upcoming Virtual Learning Sessions: LS 2: February 4, 2016, 2:00-4:00p ET LS 3: March 31, 2016, 3:00-5:00p ET LS 4: May 19, 2016, 2:00-4:00p ET Materials and recordings will be available on the ASTHO LARC page: and-child-health/long-acting-reversible- Contraception-LARC/

61 Evaluation Please take our evaluation survey so we can improve for the next call: uwznqvyoocrbex