The Florida Perinatal Quality Collaborative (FPQC) launched its latest maternal initiative, Access LARC, on Friday, November 3, 2017.

Teams from eight Florida hospitals, one OB residency program, and two hospitals from North Carolina along with representatives from the Florida Department of Health, the Agency for Health Care Administration and nine Medicaid Managed Care Organizations met at the Second Harvest Food Bank in Orlando to learn about the evidence and benefits of immediate postpartum Long Acting Reversible Contraceptives (LARC).

With up to 59% of pregnancies in Florida either unwanted or mistimed, it is important to provide access to comprehensive reproductive life counseling and contraception options. The aim of the initiative is to increase women’s contraceptive choices by facilitating the establishment of LARC placement during the delivery hospitalization in the participating hospitals and residency programs.

Because a large part of the work involves revising or creating processes in a variety of departments throughout the hospital to allow immediate postpartum placement of LARCs, the initiative has been broken into two phases: Pre-Implementation and Implementation. Different from previous FPQC initiatives, the kickoff training focused on the Pre-Implementation phase only. Another difference with this kickoff was the inclusion of Medicaid Managed Care Organization representatives who will be pivotal in working with hospital teams to revise billing processes for immediate postpartum LARCs.

The meeting began with a presentation by Dr. William Sappenfield, Director of FPQC, and Dr. Rachel Rapkin, Access LARC Physician Lead, covering the evidence, need and background for immediate postpartum LARCs as well as reviewing Frequently Asked Questions. Rachel Logan, a doctoral student from the University of South Florida, presented information about a systematic review to identify patients’ and providers’ knowledge, attitudes and beliefs regarding immediate postpartum LARC use as described in the literature. She discussed next steps to solicit Florida-specific feedback via focus groups and to develop education materials for providers and patients regarding best practices regarding contraceptive counseling and shared decision-making.

The Pre-Implementation section of the toolkit was presented by members of the advisory committee, including Faye Johnson, Dr. Pamela Schwartz, Dr. Elicia Coley, and Dr. Eina Fishman, along with Dr. Rachel Rapkin, Betsy Wood and Emily Bronson.

The feature presentation of the morning centered on the successful implementation of immediate postpartum LARC in South Carolina. This was the first state with Medicaid unbundling LARCs from the delivery diagnostic related group (DRG) charges which incentivized hospitals to provide this service during the delivery hospitalization. Judy Burgis, MD, FACOG, Endowed Chair of the Department of OB/GYN at the University of South Carolina School of Medicine, and Rhonda Quinones, MSN, RNC, NEA-BC, Director of Women’s and Neonatal Health at Palmetto Health outlined their immediate postpartum LARC journey, including barriers to implementation and how they were overcome. This was a very popular presentation, eliciting many questions and discussions.

During a working lunch, the hospital teams along with managed care representatives brainstormed their first steps in their Access LARC journey and discussed these steps after lunch. The day’s program ended with a presentation by Dr. Sappenfield on the structural measures to be reported by the participating facilities and included the data reports that will be provided to participants.

Evaluations were overwhelmingly positive with participants noting that it was a great idea to include insurers and state stakeholders, and that teams are very excited to improve access to LARC.

Each hospital and residency program has assembled a quality improvement team including physician, nurse, and administrative champions. During the 15 months of the initiative, FPQC will conduct periodic webinars, provide monthly quality improvement data reports, an online toolbox with a general toolkit, resources and slide sets, and technical assistance. Funding for Access LARC is provided by the Florida Department of Health’s Title V Block Grant.

 

For more information on the Access LARC Initiative, visit FPQC.org.