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    The ACA Sets the Stage for Women’s Health Improvement

    The state of women’s health in the United States stands to gain substantially from implementation of the Affordable Care Act (ACA). According to a report published by the Office of the Assistant Secretary for Planning and Evaluation, the ACA is projected to extend coverage to 14 million uninsured women by 2016 through qualified health plans available through health insurance marketplaces or through Medicaid expansion in participating states. A regular source of coverage, combined with the elimination of cost-sharing for many preventive services, including cervical cancer screening and some prenatal services, is expected to remove financial barriers to accessing these services. Additionally, the ACA includes multiple provisions that strengthen and support innovations in the delivery of primary care, especially through the adoption of patient-centered medical homes (PCMH). Because of the comprehensive and coordinated style of care delivered in PCMHs, not only will women be able to access services, but they will also be more likely to receive the full breadth of preventive care they need.

    Many women who gain coverage through the ACA are likely to seek care at their local federally qualified health center (FQHC). States can implement policies that FQHCs are able to leverage in order to improve women’s access to high quality preventive services. The National Academy for State Health Policy (NASHP), through a Cooperative Agreement with the Health Resources and Services Administration (HRSA), researched and identified FQHC practices and state policies associated with high performance in cervical cancer screening in seven states—Colorado, Maine, Maryland, New York, Texas, Vermont, and Virginia. Regular screening is correlated with decreased cervical cancer incidence and mortality. Here are examples of how policies in Vermont are facilitating improvements in care for women at the practice level:

    • Vermont’s Blueprint for Health, the state multi-payer chronic care prevention and management program, contracts with a staff member from the state Primary Care Association to provide on-site assistance with continuous quality improvement and PCMH practice transformation. Vermont FQHCs have been able to utilize this resource as they transform into PCMHs—a key component of participation in the Blueprint. FQHC interviewees emphasized that they are able to leverage many components of the PCMH, such as the implementation of an electronic medical record (EMR) system, to improve their cervical cancer screening rates.
    • NE Washington County Health Center, a FQHC in rural Vermont, utilizes information available through the Blueprint for Health’s statewide registry, DocSite, to actively manage patients who are due for or have had a positive cervical cancer screening. Staff members flag necessary tests and abnormal results within their EMR in order to ensure that patients receive appropriate follow-up.

    You can learn more about facilitating improvements to women’s health care through cervical cancer screening in a recent report highlighting state policies and in a brief featuring innovative FQHC practices.

    NASHP is currently undertaking another study to identify state- and FQHC-level policies that result in high rates of women entering prenatal care during their first trimester of pregnancy. Access to prenatal care within the first trimester has been shown to minimize the risk for pregnancy-related complications and improve health outcomes for both mothers and infants. NASHP is interviewing FQHCs and state policymakers in four states with high performance in this area—California, Illinois, Massachusetts, and Washington. 

    Stay tuned to State Refor(u)m as we feature more innovative FQHC and state policies affecting women’s health! We will also profile best practices in early prenatal care entry from high performing FQHCs in two HRSA Grantee Spotlights, a webinar, and peer learning calls.

    Does your state have innovative policies or programs to track the quality of women’s health care, or improve women’s access to preventive services? Let us know in a comment below.

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