The Family Planning Program at Morris Heights Health Center (MHHC), located in the South Bronx, has been a model for positive change as its team has worked to increase access to evidence-based contraceptive care at its 4 Title X-funded sites. Family planning is totally integrated into the broader health services provided within this federally qualified health center (FQHC)--there are no specific days or hours delineated as "family planning." Although such integration minimizes missed opportunities for meeting the reproductive health needs of clients, it has created service delivery challenges. In order to effectively address these challenges, MHHC developed a multifaceted approach. With the support of the Executive Leadership team, the agency established a multidisciplinary Long-acting Reversible Contraception (LARC) Summit, which addressed topics such as data, coding and documentation, supply chain, and billing. The Summit team convened several times to determine key initiatives and assess their effectiveness as they were implemented.
The team prioritized collecting accurate data. Susan Billinghurst-Hamlet, the Project Director, used this data to engage senior leaders, who ultimately prioritized improvement efforts aimed at addressing gaps identified by the data. The agency also worked rigorously on improving financial systems. The Family Planning Program pulled together a multidisciplinary team, combining expertise across different departments, to discuss what was needed and who needed to be involved to create an accurate and comprehensive budget for the family planning program, increase enrollment in the Family Planning Benefit Program, and ensure full reimbursement from third-party payers. The NYS COE provided on-site technical assistance to support MHHC with this formidable fiscal work.
We spoke with Vanessa Arenas, MHHC's Family Planning Program Coordinator, about the changes that dramatically increased contraceptive coverage and LARC use at MHHC, set into motion by the NYS COE's 2013 Learning Collaborative. Arenas cited the greatest barrier to increasing client access to contraception, including highly effective LARC, at her agency as competing priorities. To increase the priority level placed on providing contraceptive care as part of any visit - regardless of the reason for the visit - a culture shift was necessary. "We needed family planning to be seen as an integral part of comprehensive primary care," noted Arenas. "To do this, we had to make sure that people saw [family planning] as critical to overall patient health and well-being, and its provision as a fiscally sustainable practice."
Today, more patients are leaving MHHC with their contraceptive method of choice than ever before - a four-fold increase from 2012 to December 2014! - and MHHC has the highest LARC use rate of any FQHC in New York State, with 13% of all eligible females leaving with a LARC as their method of choice. MHHC Family planning team recommends as advice to its family planning peers putting together a multidisciplinary team to spread the message, push changes ahead, and address issues of staff buy-in as they arise. Also stressed is the importance of maintaining accurate data collection. "Data is a tool--a tool for identifying what problems to focus on and whether your changes worked. It has to be under constant review." Next up, the Family Planning Program is taking what they learned through the Learning Collaborative and subsequent improvement work to increase the percentage of negative pregnancy test visits leaving with a contraception method, as well as to improve their outreach efforts to increase access among target populations. The NYS COE looks forward to seeing what changes MHHC will implement through this work and learning from their successes.