Improving Family Planning Services at Community Health CentersAs a result of the Affordable Care Act, federally qualified health centers (FQHCs) were expected to double the number of patients they serve. FQHCs provide comprehensive primary and preventive care regardless of a patient’s insurance status or ability to pay.
Public Health Solutions
Special Projects Fund
September 2013 – October 2015
As a result of the Affordable Care Act, federally qualified health centers (FQHCs) were expected to double the number of patients they serve.
FQHCs provide comprehensive primary and preventive care regardless of a patient’s insurance status or ability to pay. Although FQHCs are required to provide family planning services to patients, many do not receive funding through the U.S. Department of Health and Human Services Title X Family Planning Program, and are therefore neither properly equipped nor trained to provide the same scope of services as their funded counterparts.
NYHealth awarded Public Health Solutions a grant to pilot a quality improvement collaborative model to close the gap and integrate evidence-informed best practices in contraceptive care at non-Title X-funded FQHCs in New York City. Under this grant, Public Health Solutions educated and trained health center staff to ensure the operational changes at each site align with evidence-based standards of care. The project aimed to measurably improve FQHCs’ contraceptive service provision and reduce unintended pregnancies through high-quality family planning services—offering counseling on a wide range of approaches from abstinence to pharmaceuticals.
Outcomes and Lessons Learned
- Recruited and contracted with four FQHCs, each of which then formed multidisciplinary quality improvement teams;
- Provided education and training on integrating best practices for contraceptive services, identified areas for improvement, and offered technical assistance for practice changes;
- Increased the percentage of women annually screened for pregnancy intention from 3% to 80% at participating FQHCs;
- Increased the percentage of women who initiated or continued an effective contraceptive method from 2% to 55% among those not seeking pregnancy;
- Resulted in 75% of clinical providers across participating sites providing contraceptive-related care; and
- Developed a comprehensive toolkit that provides guidance for primary care practitioners seeking to improve their contraceptive services and patient outcomes.
Over the grant period, Public Health Solutions refocused its aim on improving contraceptive services rather than family-planning services at large. Although the project was successful overall—improving the quality of contraceptive care among the participating FQHCs—it faced several challenges and limitations during its course. One notable and unanticipated barrier that both altered the original activities and affected the expected outcomes was the limitation of New York State Medicaid fee-for-service reimbursement to FQHCs for certain reversible contraceptive methods (i.e., IUDs and implants). To mitigate this barrier, Public Health Solutions worked with the participating FQHCs to create a robust referral and follow-up process for patients seeking these methods.
Co-Funding and Additional Funds Leveraged: Public Health Solutions received $1.3 million in additional funds to the total project cost from a national funder that conducts its giving anonymously, allowing for a longer pilot period and for two additional FQHC sites to participate along with the four sites supported by NYHealth.