ASTHO LARC Learning Community Virtual Learning Session Training. February 19, :00-4:00p ET , ext #

Transcription

1 ASTHO LARC Learning Community Virtual Learning Session Training February 19, :00-4:00p ET , ext #

2 Agenda 2:00 Welcome and Introductions 2:10 State Team Updates 2:40 State Presentation: Georgia 3:10 State Presentation: South Carolina 3:40 Abstract Proposal on LARC Evaluation 3:55 Next Steps, Homework 4:00 Adjourn

3 Webinar Objectives Discuss learning community state team progress in the three months since the last learning session. Learn about provider training for LARC immediately postpartum and resources and relationships that have enhanced Georgia s work. Learn about provider training for LARC immediately postpartum and leadership and strategies that have moved South Carolina s work forward. Discuss proposed abstract on inserting LARC immediately postpartum.

4 Welcome and Introductions Welcome from ASTHO Dr. Lisa Waddell Chief of Community Health and Prevention

5 Training Framework Policy Are there any supporting/hindering policies for providing training? Provider What does successful training for providers look like? Pharmacy How do you design training and content for pharmacists? Billing and Coding What does successful billing/coder training for providers look like? How can we successfully use pilot sites to take information back to the ones setting up the coding? Cross Cutting Issues: where does leadership for training come from? What roles do key stakeholders or professional organizations have? What success stories can translate to other states

6 State Team Introductions LARC Learning Community State

7 Team Updates: Round Robin Each state will present for 3-5 minutes Alphabetical order Following state updates, time will be allotted for questions or reactions.

8 State Team : Round Robin Colorado Georgia Iowa Massachusetts New Mexico South Carolina

9 Provider Training Immediate Postpartum LARC Placement Georgia s experience

10 Collaborative experiences Department of Community Health Department of Public Health Georgia Ob/Gyn Society Georgia Perinatal Quality Committee Regional Perinatal Centers Local, regional and national agencies

11 Training approach Peach State grant to Georgia Ob/Gyn Society Train providers at six regional perinatal centers Residency Programs Areas of population density Referral areas

12 Key components Information about the Medicaid policy Why this policy is good for Georgia What is good about LARC devices Why immediately postpartum is a great time for placement Billing and reimbursement From CMO Medical Director

13 Key components (continued) Discussion of FAQ Breastfeeding Expulsion Strings Demonstration Hands on with pelvic models Setting the stage for next steps and additional stakeholders

14 Inspiration

15 Additional training efforts Similar trainings in non-rpc settings Georgia Ob/Gyn Newsletter Webinar Annual meeting talk Annual meeting simulation lab Georgia Perinatal Quality Committee Maternal focus initiative Department of Public Health Incorporating contraceptive counseling at initial prenatal visit

16 Some findings Developing institutional champions State-level learning and problem-solving

17 Provider Training: Immediate Postpartum LARC Insertion (Georgia) Questions?

18 Inpatient Nexplanon Experience Amy H. Picklesimer, MD, MSPH Associate Professor Department of Obstetrics and Gynecology University of South Carolina - Greenville

19 WHY LARC?

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24 WHY NOW?

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26 Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents.

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28 Inpatient LARC August 2013 to Present Reimbursement Policy UB-04 must have following: HCPCS code for device ICD-9 Surgical Code ICD-9 Diagnosis Code

29 Instructions for Medicaid Claims Codes must be included on the UB-04 or Institutional Claim so that a gross level credit adjustment can be generated The claim will adjudicate and the DRG portion will be paid in the weekly claims payment cycle. The LARC reimbursement will process as a gross level credit adjustment and will appear on a future remittance advice. HCPS: J7300 Intrauterine (IU) copper IUD (Paraguard) J7302 Levonorgestrel releasing IUD 52 mg (Mirena) J7303 Etonorgestrel (contraceptive) implant system (Nexplanon) ICD-9 Surgical Code: 69.7 Insertion Contraceptive Device ICD-9 Diagnosis Code: V25.02 Initiate Contraceptive NEC V25.1 Insertion of IUD

30 LARC Cost Update Code A4264 Essure J7300 Paragard J7307 Impl/Nex J7302 Mirena J7301 Skyla Previous Reimbursement Rate Current Reimbursement Rate Insertion Code Rate $1, $1, $ $ $ $67.00 $ $ $95.58 $ $ $67.00 n/a $ $67.00 *Note that all rates are the same for both in-patient and out-patient. In-patient payment is in addition to the DRG for delivery Updated October 2012

31 GREENVILLE HEALTH SYSTEM

32 Nexplanon Insertion Request in-person training by calling Merck or online at

33 Supplies Hospital Pyxis Nexplanon device and local anesthetic

34 Supplies Tackle Box Sterile gloves Sterile towels Betadine swabs Sterile marking pen 20 cc syringe 18 and 23 gauge needles Band-aid Dressing pads and wrap

35 Order sets and patient consent

36 What about breastfeeding? Observational studies of progestin-only contraceptives suggest they have no effect either on a woman s ability to successfully initiate and continue breastfeeding, or an infant s growth and development. ACOG Practice Bulletin #121, July 2011 The implant can be inserted at any time following delivery. The advantages generally outweigh real or theoretical risks if placed <1 month post-partum, and there is no restriction if placed >1 month postpartum CDC MMWR June 21, 2013

37 The risks of unintended pregnancy are much greater than the real or theoretic risks of progestin exposure in the post-partum period The advantage of Nexplanon over Depo Provera is that the implant can be removed in women who are struggling with lactation An additional advantage of Nexplanon over Depo Provera is that it has a lower peak serum concentration. After Depo Provera injection, medroxyprogesterone acetate plasma concentrations peak at 7 ng/ml 3 weeks after injection After Nexplanon insertion, etonorgestrel plasma concentrations peak at 0.8 ng/ml 4 days after insertion

38 Do women (and doctors) like it?

39 25% 20% 15% 10% 15.0% 16.0% 23.4% Nexplanon insertion rates as percentage of total deliveries 16.8% 15.2% 10.3% 18.4% 20.8% 18.4% % 0%

40 South Carolina Inpatient Nexplanon Experience: Training Questions?

41 Evaluating the Implementation of a State Medicaid Policy Initiative to Promote Long- Acting Reversible Contraception (LARC) Access during the Delivery Hospitalization Kristin Rankin, PhD Assistant Professor, Division of Epidemiology University of Illinois at Chicago School of Public Health

42 Purpose of Presentation Introduce proposal to apply the methodology of implementation science to study the roll-out of IPP LARC in early adopting states Solicit feedback, questions and support of project from ASTHO Learning Community Teams Ultimate Goals of Study: Highlight work in learning community states Systematically study implementation activities Disseminate findings to other states embarking on similar policy initiatives

43 Implementation Science (IS) IS focuses on facilitators and barriers to the wide scale implementation of evidence-based practices This study s specific focus is on success of implementation strategies to capitalize on facilitators or overcome barriers in different contexts Outcomes related to uptake of IPP LARC include: Adoption Reach Penetration Equity Acceptability

44 Specific Aims: IPP LARC Study 1. To describe variation and similarities across state- and birthing facility-level implementation strategies currently being adopted to increase access to immediate postpartum long-acting reversible contraception (IPP LARC) 2. To measure the effect of implementation strategies, alone and in combination, on outcomes at the facility, provider and patient levels, such as adoption, reach, equity, penetration and patient acceptability of IPP LARC 3. To identify whether each implementation strategy, alone and in combination with other strategies, is differentially effective according to state- and facility-level context

45 Conceptual Model Multiple Levels State Birthing Facility Provider Patient Behavior Change Wheel (Michie et al 2011)

46 Methods Mixed Methods Design Qualitative: Key Informant Interviews for exploration of state and facility-level context and implementation strategies Quantitative: Delivery Facility Survey Qualitative: Key Informant Interviews for elaboration of findings Outcome: IPP LARC rates for eligible women over time at different levels (state, facility, provider) Ascertained through Medicaid claims for codes associated with devices and procedures during delivery hospitalization

47 Research Team Team Member Affiliation Expertise Kristin Rankin, PhD (PI) UIC-SPH MCH Epidemiology, Medicaid Claims, Postpartum Health Melissa Kottke, MD, MPH, MBA Emory, GA ASTHO Team Family Planning, IPP LARC provider champion, Adolescent Health Nadine Peacock, PhD UIC-SPH Qualitative Methods, Family Planning Arden Handler, PhD UIC-SPH MCH, Medicaid Policy Sadia Haider, MD, MPH UIC-COM Family Planning, Adolescent Health Rachel Caskey, MD, MS, UIC-COM Pediatrics, Internal Medicine, Health Services Research

48 Timeline 3-year study Submission to NIH: October 2015 Earliest possible start date: July 2016 Key Informant Interviews: Facility Survey: Outcome Ascertainment: Dissemination:

49 Partnership with Learning Community Teams: Requests Now 1. Feedback about relevance and feasibility of proposed research and how it can help you (anytime) 2. Letters of Support from members of ASTHO Learning Community Teams (March 2015) When project is funded 1. Participate in Key Informant Interviews and identify other state partners to be recruited 2. Facilitate access to outcome data from state Medicaid Management Information System 3. Suggest and connect us with partners for birthing facility survey (e.g. state hospital association)

50 Related Activities of PI PI Pilot Grant (Feb 2015-Feb 2016) Examine women s experiences in Georgia (barriers and facilitators to IPP LARC, informed choice) Funder: UIC School of Public Health IL Medicaid Claims Project (Apr 2014 present) Examine factors associated with Postpartum Visit and Contraception among IL Medicaid women Funder: HRSA Maternal and Child Health Bureau Co-I Postpartum Choices Study (PI: Handler, Funder: IL Medicaid) RCT of co-located family planning services at WBV (PI: Haider, Funder: Society for Family Planning)

51 QUESTIONS? SUGGESTIONS? Contact Information: Kristin Rankin, PhD Assistant Professor, Division of Epidemiology University of Illinois at Chicago School of Public Health Phone:

52 Next Steps Learning Community Sessions: Mar. 17, 2015, 3:00-5:00p ET: Consent Apr. 23, 2015, 2:00-4:00p ET: Stocking, Supply May 12, 2015, 2:00-4:00p ET: Pay streams, Sustainability TBD Aug. 2015: In Person Learning Community?, Outreach Materials and recordings will be available on the ASTHO LARC page: Child-Health/Long-Acting-Reversible- Contraception-LARC/

53 Homework Next Call: March 17, 3:00-5:00p Present what your state is doing around training (provider, pharmacy, coding, etc.) How your state is progressing on your LARC priorities from the in-person meeting ASTHO will send a template and priorities reminder next week Review state team participants list

54 Closing and Goodbyes Closing from CDC 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

55 Framework for Future Calls Future Learning Session Topics: Consent, Stocking/Supply, Pay Streams/Sustainability, Outreach Are there supporting/hindering policies? What does successful for providers/pharmacists/clients look like? What does successful for Medicaid look like? How can we successfully use pilot sites to take information back to Medicaid? Cross Cutting Issues: Where does leadership for come from? What roles do key stakeholders or professional organizations have? What success stories can translate to other states

56 Evaluation Please take our evaluation survey so we can improve for the next call: VPzHC3fT