Implementation is an integral part of expanding access to contraceptive coverage after successful advocacy for a policy change. Too often, a new policy is passed but its enactment is limited due to the difficulty that comes with vital work like ensuring that systems are created or updated and key stakeholders and informed and educated. As more states have worked with their public and private insurers to allow long-acting reversible contraception (LARC), including IUDs and implants, to be covered in a postpartum setting, work to ensure the services are actually offered to patients is vital. This includes revising systems for billing and coding to ensure that the institutions are paid appropriately and informing and educating key stakeholders about the importance of this service.

Two NIRH partner coalitions, Young Women United, Southwest Women’s Law Center, Planned Parenthood of the Rocky Mountains and the New Mexico Perinatal Collaborative in New Mexico, in addition to the University of Utah in Utah, have engaged in rigorous efforts to facilitate implementation of a new service at hospital systems in their respective states, offering immediate postpartum long-acting reversible contraceptives (LARC) to patients who desire it.

The New Mexico Perinatal Collaborative is a coalition that is committed to improving outcomes for mothers and babies using a cultural humility and patient-centered lens. They worked to implement postpartum LARC in hospitals by creating a New Mexico-specific toolkit and training or working through any barriers with each individual hospital. The toolkit included guidance for LARC provision at every level, including for medical providers, pharmacy, finance, and IT. Four hospitals implemented postpartum LARC based on the toolkit training, including hospitals in rural areas and hospitals for the Indian Health Service, which serve primarily Native American populations.

The University of Utah’s Family Planning Research Group (FPRG) in the Department of Obstetrics and Gynecology engaged stakeholders across the state of Utah to make the case for postpartum LARC reimbursement and increase implementation. Multiple strategies were employed to advocate for immediate postpartum LARC at various levels, including holding meetings with the administration of private insurers and accountable care organizations (ACOs), as well as Medicaid to discuss the benefits of providing this service. In response, SelectHealth, an ACO and one of Utah’s largest public-private insurer, began the process of incorporating reimbursement for this service. Additionally, the Utah Women and Newborn Quality Collaborative (UWNQC), of which the University of Utah is a partner, held a Prematurity Symposium and trained providers on insertion and removal of LARC devices to increase capacity amongst medical staff. Finally, hospitals were engaged on an individual basis and technical assistance and training was provided to address implementation on an institutional level.

The New Mexico Perinatal Collaborative and University of Utah’s FPRG will be continuing their implementation work to expand access and choice in 2018.