Understanding the Net Cost of Providing Long Acting Reversible Contraception Services (LARC)
Long-acting reversible contraceptive (LARC) methods, which include the intrauterine device (IUD) and contraceptive implant, are the most effective forms of reversible birth control available and are safe for nearly all women, as well as adolescents, to use. At a time where cutting edge and evidence-based clinical practices have removed many of the traditional clinical barriers to access, the Affordable Care Act (ACA), the Family Planning Benefit Program (FPBP), and the Family Planning Extension Program (FPEP) have reduced many financial barriers to accesses to LARC. In New York State, the favorable policy and financing environment has resulted in eligible women with incomes up to 223% federal poverty level having coverage for contraceptive services.
As the NYS COE has highlighted the successes of family planning providers at leveraging these opportunities and promoted best practices to increase access to LARC across the field, a common belief continues that the widespread provision of LARC is not a financially viable practice for safety net providers because of high uncompensated costs. In order to challenge these perceptions, CAI has developed the LARC Modeling Tool, which offers healthcare providers a platform to collect the information needed to determine whether they make money, lose money, or break-even when delivering this critical service. The data collected using this tool can be used to help make the "business case" for taking steps to increase access to LARC within agencies for which provision of these critical services does not result in losses. The examination of costs and reimbursements prompted by the tool also helps users to identify opportunities to improve their fiscal practices.
Of the 14 agencies in 8 states that submitted tool data to CAI as part of the Centers for Disease Control and Prevention's (CDC) Teen Pregnancy Prevention Initiative project, all but one health care provider lost money providing Mirena to clients and all but two agencies lost money providing Nexplanon. In fact, these 14 agencies made an average of $243.70, $228.55, and $218.68 providing clients with Mirena, Paragard, and Nexplanon, respectively. The NYS COE also piloted the tool among both 2013 and 2014 Learning Collaborative participating agencies, of which only one agency that completed the tool did not make money or break even providing Mirena, Paragrad, and Nexplanon. Agencies participating in the pilot tests determined the tool was helpful in identifying fiscal issues that stood in the way between the robust provision of LARC to all interested clients. "The pilots demonstrated that this tool is user-friendly and can uncover and help providers address the financial barriers associated with making LARC available to every woman who wants it," said Dawn Middleton, CAI Vice President for Performance Management and Continuous Quality Improvement. The NYS COE anticipates that, through the use the LARC Modeling Tool, providers will be able to examine the fiscal implications of increasing access to LARC services in their agencies, and such explorations will lead to changes to fiscal practices that will improve providers' business practices.
To access the LARC Modeling Tool, agencies can visit CAI's Online Resource Center at www.caiglobal.org/LARCModelingTool. If you would prefer to utilize the LARC Modeling Tool in Microsoft Excel, please contact Julia Sheed at firstname.lastname@example.org