Metrics & Scoring Committee September 16, 2016 Consent Agenda - - PowerPoint PPT Presentation

Metrics & Scoring Committee

September 16, 2016

Consent Agenda

• Approve August minutes.
• Vice‐Chair elections

2

Updates

3

Health Plan Quality Metrics Committee

Applications opened on September 6th and will close Oct 19th

http://www.oregon.gov/oha/analytics/Pages/Quality‐Metrics‐Committee.aspx Committee members include:

• 2 health care providers
• 1 hospital representative
• 1 individual representing insurers, large employers or multiple employer welfare arrangements
• 2 health care consumer representatives
• 2 CCO representatives
• 1 individual with expertise in health care research
• 1 individual with expertise in health care quality measures; and
• 1 individual with expertise in mental health and addiction services

4

Waiver Renewal

5

Public Health Advisory Board: Accountability Metrics Subcommittee

• Last met August 25th
• Completed its review of the existing Child & Family Wellbeing measures.
• Will begin reviewing public health measure sets in September.
• On track to have final measures selected in Q1 2017.

6

Behavioral Health Collaborative

Met Aug 25th to discuss a draft problem statement and conceptual framework for a 21st century behavioral health system in Oregon.

7

Hospital Metrics

• Subject to CMS approval, the new program year (HTPP Year 4) begins

October 2016.

• OHA is seeking to align the HTPP measurement period with CCOs (i.e., switch to

calendar year). If CMS approves, Year 4 will begin January 2017

• Hospital Metrics TAG continues development of a Year 4 measure of safe
• pioid prescribing in the emergency department.
• Hospital Performance Metrics Committee next meets on Sept 21st and

will focus on setting HTPP Year 4 benchmarks and administration of the first HTPP challenge pool.

8

Equity Measure Development

9

CCOs were updated on the conversation and the upcoming request for their input at the September 12th QHOC meeting. Staff will compile results and share at future Committee meeting.

PCPCH Weighting

10

Following August Committee discussion, staff are consulting with the PCPCH program on options, and will be discussing them with the TAG next week. Staff will follow up with the Committee after the TAG meeting.

2017 Challenge Pool

11

Recap

12

In August, the Committee reviewed the 2016 challenge pool measures and considered any potential modifications, including replacing Diabetes: HbA1c Poor Control with Effective Contraceptive Use or Assessments for Children in DHS Custody. No decision was made.

Current (2016) Challenge Pool Measures

Alcohol or other substance misuse screening (SBIRT) Developmental screening Depression screening and follow up plan Diabetes: HbA1c poor control

The challenge pool is used to distribute any remaining quality pool funds (i.e., if any CCOs do not earn 100% of their pool). Currently, there are 4 challenge pool measures and if a CCO meets the benchmark or improvement target for these measures, they earn an additional payment. Challenge pool payment availability is based on how well CCOs do overall, and how well CCOs do on these specific measures.

Public Testimony

Introduction to Kindergarten Readiness

Helen Bellanca Tim Rusk

15

Why is kindergarten readiness important?

Kindergarten readiness 3rd grade reading level High School graduation Social‐ Economic success

Better lifelong health

• utcomes

Physical, emotional and social needs met

Age 0‐5 Adulthood

Kindergarten Readiness

“Although researchers, educators, parents, and policymakers agree that a child’s future academic success is dependent on being ready to learn and participate in a successful kindergarten experience, the exact definition of readiness depends on who is doing the defining. Whether a child is “ready” will always depend on the demands kindergarten places on the child and the supports it provides, as well as the child’s knowledge and skills.”

Prepared for Kindergarten: What Does “Readiness” Mean? National Institute for Early Education Research Preschool Policy Brief March 2005

How How do do most most peopl people de defi fine ne ki kinder ndergart arten readiness? adiness?

A child’s skills, behaviors, or attributes in relation to the expectations

• f individual classrooms or schools.

Wh What at do do ki kinder ndergart arten teacher teachers sa say? y?

75% of kindergarten teachers listed top three attributes for KR as: a) physically healthy, rested, and well nourished, b) able to communicate his or her thoughts and needs in words, c) curious and enthusiastic in their approach to new activities. Half listed not being disruptive, being sensitive to other children’s feelings, being able to take turns and share 10% thought being able to count to 20 or more or knowing the letters of the alphabet were important

Heaviside, S., & Farris, S. (1993). Public school kindergarten teachers’ views on children’s readiness for

• school. Washington, DC: National Center for Education Statistics.

Wh What at do do par parents of

• f pr

preschool eschool ki kids ds sa say? y?

58‐88% said counting to 20 and knowing letters was essential

• 70‐74% of parents who did not graduate HS said this was important
• 41‐50% of college grad parents said this was important
• 80‐88% of Head Start parents said this was important

Families with English as a second language say the ability to speak English is a key readiness skill

Heaviside & Farris (1993). West, J., Germimo‐Hausken, E., & Collins, M. (1995). Readiness for kindergarten: Parent and teacher beliefs (Statistics in brief). Washington, DC: National Center for Education Statistics.

Wh What at do do ki kids ds sa say? y?

Knowing and following a teacher’s rules Knowing where things are and what to do Knowing how to make friends

Dockett, S., & Perry, B. (2004). Starting school: Perspectives of Australian children, parents and educators. Journal of Early Childhood Research, 2, 171‐189

Wh What at co cont ntribute tes to to ki kinder ndergart arten readiness? adiness?

Physical/dental health Attachment with primary caregiver Emotional health of family/caregiver Opportunities for stimulation (preschool, community activities, playgroups) Social contact with other kids Being read to consistently Parental beliefs, behaviors and expectations

Wh Which fact actor

• rs contribut

ribute to to childr children en not not bei being re ready fo for ki kinder ndergart arten? n?

Physical health problems with inadequate care Poor nutrition, poor sleep habits Chronic dental pain/infections Developmental delays and disabilities (Cerebral palsy, Down’s syndrome, delay due to prematurity) Poor attachment with caregivers Poor emotional support from caregivers Witnessing or experiencing trauma or violence Limited exposure to books, materials, novel experiences, other caregivers

Building a Kindergarten Readiness metric

Oregon has made substantial investments in both health care reform (CCOs) and Early Childhood Education (Early Learning Hubs) There is a deep and persistent 2‐way connection between health and education

• Having persistent health problems makes it difficult to succeed in

school

• Low academic achievement increases the risk of lifelong health

problems

Oregon Health Policy Board and Early Learning Council Joint Subcommittee

Focus is on how CCOs and Hubs can/should work together Joint Subcommittee commissioned a Workgroup to explore possibilities for shared metrics between Hubs and CCOs

Background

The Joint Subcommittee of the Oregon Health Policy Board and Early Learning Council convened the Child and Family Well‐being (CFWB) Measures Workgroup from September 2014 ‐ September 2015 The workgroup’s charge was to develop recommendations for a shared measurement strategy for children birth through 6 years and their families that informs:

• program planning
• policy decisions
• allocation of resources
• priority setting

Helen Bellanca, Co‐Chair

Associate Medical Director, Health Share of Oregon

Tim Rusk, Co‐Chair

Executive Director, Mountain Star Family Relief Nursery

Pooja Bhatt

Early Learning Manager, United Way‐ Columbia Willamette

Sujata Joshi

Project Director, NW Portland Area Indian Health Board

Cade Burnett

Child & Family Services Director, Head Start, Umatilla‐Morrow Counties

Martha Lyon

Executive Director, Community Services Consortium for Linn, Benton and Lincoln Counties

Janet Carlson

County Commissioner, Marion County

David Mandell

Early Learning Policy and Partnership Director, Early Learning Division, Oregon Department of Education

Bob Dannenhoffer

Interim CEO, Umpqua Community Health Center

Alison Martin

Assessment and Evaluation Coordinator, Oregon Center for Children and Youth with Special Health Needs

Donalda Dodson

Executive Director, Oregon Child Development Coalition

Katherine Pears

Senior Scientist, Oregon Social Learning Center

Aileen Alfonso Duldulao

Maternal and Child Health Epidemiologist, Multnomah County Health Department

T.J. Sheehy

Research Director, Children First for Oregon

R.J. Gillespie

Pediatrician and Medical Director, Oregon Pediatric Improvement Partnership

Bill Stewart

Director of Special Projects, Gladstone School District

Andrew Glover

Youth Villages, Inc.

Peter Tromba

Policy Research Director, Oregon Education Investment Board

Matthew Hough

Pediatrician and Medical Director, Jackson Care Connect CCO

Consultant: Michael Bailit Staff: Dana Hargunani & Rita Moore

Workgroup Definitions

Child and family well‐being is the state of having generally positive experiences with education and employment, good relationships with family and friends, adequate financial resources to meet basic needs and wants, physical health and comfort, resiliency, freedom from chronic stressors such as discrimination and oppression, and a consistent sense of belonging to a community. Child and family well‐being is when families are happy, healthy and successful in achieving their

• wn life goals.

Joint Accountability Measures

Recommendation: Child and Family Well‐being Measures Library

Early Learning Hub Accountability Measures CCO Accountability Measures Monitoring Measures

CFWB Dashboard

Recommended CCO Accountability Measures

Children Who Received Well‐Child Visits in the First 15 Months of Life Children Who Have Received Developmental Screening by 36 Months Children Ages 3 to 6 That Had One or More Well‐Child Visits with a PCP During the Year Among CYSHCN6 who needed mental health/counseling, percent of CYSHCN who received all needed care Percentage of children less than 4 years of age on Medicaid who received preventive dental services Getting Care Quickly Composite ‐ CAHPS 5.0H Prenatal and Postpartum Care: Timeliness of Prenatal Care Among CYSHCN who needed specialized services, percentage of CYSHCN who received all needed care. Childhood Immunization Status: The percentage of children 2 years of age who have received specific immunizations. Adolescent Well‐Care Visit SBIRT Current CCO incentive measure. Current state performance measure.

Recommended Joint CCO and Hub Accountability Measures

Kindergarten Assessment: Average Score by Domain Kindergarten Attendance Rate Rate of Follow‐up to Early Intervention after Referral Preventive Dental Services for Children <4 Well Child Visits for Children 3‐6 Years Developmental Screening by 36 months Receipt of Needed Specialized Services Among Children and Youth with Special Health Needs

Child and Family Well‐being Dashboard

Domain Measure

Relationships

• Child Abuse and Neglect per 1,000 Children
• Disproportionality in Foster Care

Economic Stability

• Child Poverty Rate
• Food Insecurity Among Children

Community

• Child Lives in a Supportive Neighborhood
• Rate of Crimes Against Persons, Property and Behavioral Crimes
• Adverse Childhood Experiences Among Adults

Comprehensive Person‐ Centered Health Care

• Developmental Screening by 36 Months
• Well‐Child Visits for Children Ages 3 to 6

Early Childhood Care and Education

• Kindergarten Assessment: Average Score by Domain
• Early Childcare and Education Slots Available per 100 Children

Comprehensive Person‐ Centered System Integration

• Percentage of Children Lifted out of Poverty by Safety Net

Programs

• Rate of Follow‐up to Early Intervention after Referral
• Kindergarten Attendance Rate

Kindergarten Readiness Bundled Metric

Agreement:

• Accountability metric, not a monitoring metric
• Outcome oriented, not process measures
• Multifactorial, with health, learning and family components
• Clinical data source, not claims‐based

Lack of agreement:

• Can either CCOs or EL Hubs be accountable for kindergarten readiness? Can both be jointly

accountable even if neither one is individually accountable?

• Is the Kindergarten Assessment a good indicator for early learning component?
• Can we reasonable measure family‐level factors (especially in a pediatric practice)?
• Which factors should be included in the bundle?
• Can we even operationalize a bundled metric?

Kindergarten Readiness Bundle discussed

Health Care Components 1. Well Child Check completed in past year 2. Vision is normal or corrected 3. Hearing is normal or addressed 4. Immunizations are up to date 5. Dental exam shows no active decay 6. Children with a special health care need have a cross‐system, family‐centered, actionable shared care plan in place 7. Family is screened for food insecurity/hunger 8. Developmental screening has been completed in past year with F/U Family Components 1. Parent/caregiver assessed for depression in past year 2. Parent/caregiver assessed for substance use disorder in past year 3. Parent/caregiver assessed for domestic violence in past year Early Learning Components 1. Children have behavior that facilitates learning (CBRS) 2. Children have literacy skills 3. Children have numeracy skills

Questions?

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Introduction to Medication Therapy Management Measures

Nicole O’Kane, PharmD, Clinical Director, HealthInsight Oregon Woody Eisenberg, MD, Sr. VP, Performance Measurement and Strategic Alliances, Pharmacy Quality Alliance

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Outline

• Background
• Medication Therapy Management (MTM) & State Medicaid Programs
• MTM & Medicare Part D Measures
• Potential MTM Measure for CCO Populations

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Definition of MTM

• The goal of Medication Therapy Management (MTM) services is to
• ptimize the therapeutic outcomes of individual patients.
• MTM services are independent of, but can occur in conjunction with,

the dispensing of a medication product.

• Public definition: It is a program to help you and your doctor make

sure the medicines you take are safe and work well for you.

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

The Core Elements of MTM

• Review all current medications
• Assess medication‐related problems
• Provide a personal medication record

A comprehensive, reconciled list of all of the patient's medications to the patient and other clinicians for self‐management, care coordination and continuity

• Compile a medication‐related action plan for tracking progress in self‐

management

• Identify cases needing intervention including collaboration with other

clinicians

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

MTM Service Codes

CPT Codes Description

99605 Medication therapy management service(s) provided to an individual patient, face‐to‐face, with assessment and intervention if provided; initial 15 minutes, new patient 99606 Initial 15 minutes, established patient 99607 Each additional 15 minutes (List separately in addition to code for the primary service) (Use 99607 in conjunction with 99605, 99606)

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

MTM & State Medicaid Programs

• Many state Medicaid programs cover Medication Therapy Management (MTM)

services

• Services are underutilized
• A few states have promoted and studied their program expansions including
• Minnesota
• Ohio

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

MTM & State Medicaid Programs

Minnesota ‐ Fee‐For‐Service, Managed Care, and Ryan White Medicaid Programs

• Department of Human Services partnered with University of Minnesota College of

Pharmacy

• Eligibility based on number of prescriptions and at least one chronic condition
• MTM services via interactive video allowed starting in 2010
• Data warehouse evaluated MTM service billing codes (2008‐14):
• 201 pharmacists from 110 organizations delivered more than 29,000 MTM services to

more than 11,000 patients

• MTM services resulted in a 31% reduction in total health expenditures per patient,

from $11,965 to $8,197, and a 14% increase in meeting patient’s goals. Overall ROI: >$12:$1.

• In 2011, 3.7% of eligible members received MTM service

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

MTM & State Medicaid Programs

Ohio ‐ CareSource with 900,000 managed Medicaid members

• State partnered with Ohio Pharmacy Association and the

OutcomesMTM vendor

• Eligibility based on a combination of number and total cost of

prescriptions and existence of chronic conditions

• 1,492 pharmacies delivered more than 100,000 MTM services in first

12 months

• Estimated number of serious events averted by MTM: 2246
• ROI $1.35:$1 drug cost savings & $4.40:$1 overall savings

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

MTM & State Medicaid Programs

In Oregon, MTM services are covered when the services are associated with a covered condition on the prioritized list. In most cases, non‐ Medicare Part D MTM services have been limited to:

• Pharmacists employed by Coordinated Care Organizations (CCOs)
• Independent contracts between CCOs and pharmacists
• Healthcare provider groups who self‐fund medication management

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

MTM Eligibility Criteria

Can be set by the Oregon Health Authority Eligibility Criteria Example: Medicare Part D

• Part D enrollees who have multiple chronic diseases, are taking multiple drugs, and are likely

to incur annual costs for covered drugs that exceed a predetermined level

• The MTM requirements establish both a ceiling and a floor for the minimum number of

conditions that may be required.

• Plans may target beneficiaries with any chronic diseases or target beneficiaries having

specific chronic diseases.

• Core chronic diseases include: diabetes, heart failure, dyslipidemia, hypertension, COPD,

asthma, osteoporosis, depression, RA, CVD

• Plans may target beneficiaries based on number of chronic medications and/or target

certain medications

• Plan are encouraged to consider including diseases in their targeting criteria to meet the

needs of their patient populations and improve therapeutic outcomes.

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Data Sources Used for Eligibility & Measurement

• Almost all MTM programs use drug claims data to identify eligible

beneficiaries for their MTM programs

• In addition, some MTM programs also use medical data to identify eligible

beneficiaries

• Plans use other types of data to aid with identification (4.3% use

information collected from the beneficiaries, and 3.7% use laboratory data and health assessments).

• Interventions can be monitored through drug claims, MTM billing codes,

SNOMED codes, plan‐reports (audited) These are not mutually exclusive categories.

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Sample MTM Measure: Medicare CMR Completion Rate

Description Calculates the percentage of beneficiaries who met eligibility criteria for the MTM program and who received a Comprehensive Medication Review (CMR) with a written summary in the CMS standardized format A CMR is a systematic process of collecting patient‐specific information, assessing medication therapies to identify medication‐related problems, developing a prioritized list of medication‐related problems, and creating a plan to resolve them with the patient, caregiver and/or prescriber.

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Natio National Aver al Average ages for 2016 (using for 2016 (using 2014 data) 2014 data)1

MA-PD: 30.9 % 2.3 stars PDP: 15.4 % 2.3 stars

MA‐PD = Medicare Advantage prescription drug plan; PDP = prescription drug plan 1. Medicare 2016 Part C & D Star Rating Technical Notes

CMR Completion Rate Measure 2016 Cut Points

CMR CMR Com Complet letion Rat Rate Measur Measure 2016 Cut e 2016 Cut Point Points 1

Type 1 Star 2 Star 3 Star 4 Star 5 Star

MA‐PD < 13.6% ≥ 13.6% to < 36.2% ≥ 36.2% to < 48.6% ≥ 48.6% to < 76.0% ≥ 76.0% PDP < 8.5% ≥ 8.5% to < 16.6% ≥ 16.6% to < 27.2% ≥ 27.2% to < 36.7% ≥ 36.7%

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

CMR Completion Rate Measure Expectations & Challenges

Why It’s Good

• Improves patient care
• Promotes patient interaction
• Room for improvement
• Opportunity to improve
• ther quality measures
• Fosters new models of

pharmacist care Why It’s Imperfect

• Patients opt out
• Resource & reimbursement

constraints

• Process measure
• May promote “check‐the‐box”

situation vs. improved patient care

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Looking Forward to Outcomes‐Based MTM Measures

“The CMR rate measure is an initial measure of the delivery of MTM services, and we continue to look forward to the development and endorsement

• f outcomes‐based MTM measures as potential

companion measures to the current MTM Star Rating.” 1

1. CY2017 Final Call Letter, p114

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Other MTM Measure Concepts Under Development

• 1. Percentage high‐risk patients who receive MTM services from a pharmacist within 7

days from hospital discharge

• 2. The percentage of high‐risk patients that received MTM from a pharmacist within 7

days post hospital discharge that are readmitted within 30 days of their discharge.

• 3. Percentage of targeted beneficiaries with one or more DTPs (drug therapy problems)
• 4. Percentage of DTP recommendations that were implemented
• 5. Percentage of adult health plan members who met eligibility criteria for MTM services

who receive an immunization status assessment within the eligibility period

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Potential MTM Measure for CCO Populations

• No standard Medication Therapy Management (MTM) or

Comprehensive Medication Review (CMR) measure exists for Medicaid populations.

• Possible to define a basic measure similar to Medicare Part D CMR

Completion Rate Measure such as:

The percentage of members who met eligibility criteria for the MTM program and who received at least one MTM service during the benefit year

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Potential MTM Measure for CCO Populations

The percentage of members who met eligibility criteria for the MTM program and who received at least one MTM service during the benefit year

• Use MTM billing codes to identify number of members in numerator
• Use continuous enrollment criteria and standard eligibility definitions

to define denominator

• Initially a non‐financial incentive measure

www.pqaalliance.org Pharmacy Quality Alliance

703.690.1987

Questions / Discussion

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703.690.1987

References

• 1. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General 2011.

Accessed 2016-09-09 @ https://www.accp.com/docs/positions/misc/Improving_Patient_and_Health_System_Outcomes.pdf

• 2. National Conference of State Legislatures. Medication Therapy Management Pharmaceutical Safety & Savings. March 2014.

Accessed 2016-09-09 @ http://www.ncsl.org/research/health/medication-therapy-management.aspx

• 3. Many happy returns: Ohio-based Medicaid plan pays pharmacists for MTM, saves money Pharmacy Times May 01, 2014.

Accessed 2016-09-09 @ http://www.pharmacist.com/many-happy-returns-ohio-based-medicaid-plan-pays-pharmacists-mtm-saves- money

• 4. Center for Medicare & Medicaid Services. Medication Therapy Management. Accessed 2016-09-09 @

https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.html

• 5. LaBella S., Barnes K. Journal of the American Pharmacists Association 2015 55:2 (e174). DOI 10.1331/JAPhA.2015.15515
• 6. Gainor K. Journal of the American Pharmacists Association 2015 55:2 (e174). DOI 10.1016/JaPhA.2016.03.014
• 7. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management.

3rd ed. New York, NY: McGraw-Hill; 2012

EFFECTIVE CONTRACEPTIVE USE (REVISITED)

Effective Contraception Use Metric

Proportion of women at risk for unintended pregnancy who are using an effective method of contraception

Denominator: Women age 15‐50 who are physiologically capable

• f pregnancy

Numerator: Women with evidence of Tier 1 or 2 contraception during the measurement period (tubal ligation, IUD, implant, pills, patch, ring, shot, diaphragm)

Why is this important?

Goal is to prevent unintended (unwanted) pregnancy A woman with an unintended pregnancy is:

• less likely to seek early prenatal care
• more likely to expose the fetus to harmful substances
• at greater risk of depression
• at greater risk of physical abuse
• at greater risk of having her employment, education and relationship with her partner derailed

Brown, S. S., & Eisenberg, L. (Eds.). (1995). The best intentions: Unintended pregnancy and the well‐being of children and families. Washington, DC: National Academies Press

Why is this important?

Goal is to prevent unintended (unwanted) pregnancy A child of an unintended conception is at greater risk of:

• being born at low birthweight
• dying in his/her first year of life
• being abused or neglected
• not receiving sufficient resources for healthy development

Brown, S. S., & Eisenberg, L. (Eds.). (1995). The best intentions: Unintended pregnancy and the well‐being of children and families. Washington, DC: National Academies Press

Proportion of Births that were Unintended

PUBLIC HEALTH DIVISION Reproductive Health Program

62

56.2% 51.7% 54.7% 53.2% 55.3% 52.2% 55.7% 53.0% 51.8% 54.2% 55.2% 48.5% 48.2% 32.0% 33.3% 29.8% 28.5% 25.4% 25.5% 23.3% 26.2% 29.2% 28.6% 27.7% 23.5% 22.9% 0% 20% 40% 60% 80% 100% 1998-99* 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Medicaid-paid births Non-Medicaid-paid births

Data Source: Oregon PRAMS

http://www.guttmacher.org/pubs/FB‐Unintended‐Pregnancy‐US.html

Why are women who do not want to be pregnant not using contraception?

I thought I couldn’t get pregnant at that time 31% I thought I was sterile or my partner was sterile 10% My partner did not want to use anything 22% I had side effects from my birth control 11% I had problems getting birth control when I needed it 6% Other 20%

Source: Oregon PRAMS 2011

Primary care screenings identified as indicators of high quality care

Depression screening (PSQ‐2 and 9) Alcohol misuse (SBIRT) Cervical cancer screenings (Paps) Breast cancer screenings (exams, mammography) Diabetes screening (blood glucose and HgbA1c)

Lifetime risk of those conditions

Percent of women who experience this condition in their lifetime

Cervical cancer 0.7% Alcohol misuse 10% Breast cancer 12% Depression 27% Diabetes 35.5% Unintended pregnancy 48%

Yes, but what about the perception that we are unfairly or unethically targeting poor women with our contraception efforts?

30 years of data

Lowest income women All women Highest income women

Access to contraception for low‐income women

• More than half of women who need contraception need publicly‐funded

services

• The number of women needing publicly funded contraception services

increased by 17% from 2000 to 2010

• Failing to cover contraception was ruled as a violation of the federal Civil

Rights Act as amended by the 1978 Pregnancy Discrimination Act

• The Federal ACA includes contraception care as a core preventive service

that all women are entitled to without cost sharing or co‐pays.

Frost JJ, Zolna MR, Frohwirth L. Contraceptive needs and services, 2010. New York (NY): Guttmacher Institute; 2013. Available at:http://www.guttmacher.org/pubs/win/contraceptive‐needs‐2010.pdf.

All of these speak to the long history of poor women having less access to contraception than their higher‐income peers. Having a quality metric in contraception is a key step in giving low income women equal access to high quality primary care.

Next Meeting: October 21st