The Challenge

The United States’ Title X program was established by congress in 1970 to ensure that every person — regardless of background or insurance status — has basic access to reproductive health care and family planning counseling. These essential services allow Title X clients to manage desired pregnancy timing and spacing, leading to positive outcomes for individuals, families and their children. Nearly half of reproductive-age women in the US depend on Title X funds. Yet by 2015 — 45 years after launching the program — Title X still had no standard measures of network-level quality of contraceptive care. The absence of reliable and valid metrics for clinical care greatly limited the ability of the Title X program and reproductive health professionals to address gaps and improve their services.

The Project

Far Harbor was invited by the HHS Office of Population Affairs (OPA) to provide statistical analysis on the first clinical performance measures for contraceptive care to address the measurement gap. The Far Harbor team was responsible for refining the statistical programs that calculated these new measures, determining whether the measures were reliable and valid using administrative claims data, and then presenting the findings to the National Quality Forum (NQF) for endorsement.

Our Approach

Far Harbor statisticians developed a robust methodology for multilevel claims data analyses, building evidence that the measures were reliable and valid. This new reliability analysis method utilized empirical Bayes for estimation; and took advantage of multilevel estimation to establish measure validity.

Our methods were shown to be appropriate even with small patient populations (such as within facilities), a frequent occurrence with administrative claims data. The methodology was presented to the National Quality Forum’s technical review panel and is in development for future publication.

The Impact

Our presentations of reliability and validity findings in 2016 and in 2020 helped OPA to obtain the National Quality Forum’s (NQF) endorsement of the Contraceptive Care measures, enabling their use for improvement in clinical care.

After the initial endorsement, many health care organizations implemented the measures, including a national network of family planning providers, academic health systems, and federally qualified health centers.

The Centers for Medicaid and Medicare Services (CMS) Adult and Child Core Sets then adopted all Contraceptive Care measures as key service quality indicators for Medicaid and CHIP programs across the country, for which CMS now publicly reports these measure rates by state and age groups. The NQF endorsement allows states, health plans, service delivery organizations, and health systems to leverage the measures to assess their performance in family planning and improve the quality of its reproductive health services.

Far Harbor continues to assist OPA and partners utilize the measures for quality improvement and reporting. We help update the codebase annually and respond to technical assistance requests from stakeholders as needed.