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Immediate Postpartum Long-Acting Reversible Contraception (IPLARC)






52%

The percentage of Illinois pregnancies that are unintended.

29%

The percentage of pregnancies that occurred prior to the recommended health prenancy spacing interval of 18 months after delivery.

2015

The year Illinois Medicaid announced that Immediate Postpartum Long-Acting Reversible Contraception was reimbursable outside the delivery bundle.

40%

The percentage of births that take place in an Illinois hospital participating in the IPLARC initiative.
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Expanding access to highly effective contraception

Long-acting reversible contracptive (LARC) methods, including intrauterine devices and contraceptive implants, are not only safe – they are the most effective form of reversible contraception. Several women’s health and physician organizations, including the American College of Obstetricians and Gynecologists (ACOG), support the expansion of access to LARCs immediately after delivery. ILPQC in 2018 deployed a statewide initiative to increase use of ACOG guidelines and support hospital-based teams to develop the capacity and resources to offer IPLARC

Initiative Aim and Outcome

Aim: Within 9 months of initiative start, >= 75% of participating hospitals will be providing immediate postpartum LARC.

Objectives:

  • 1.
    Patients receive comprehensive contraceptive counseling, including the option of IPLARC, prenatally and during the delivery admission.
  • 2.
    Patients who desire and are eligible for IPLARC receive it.
  • 3.
    Billing is facilitated and reimbursement is received.
  • 4.
    Providers and staff, including new hires, receive ongoing IPLARC education.

IPLARC Clinical Leadership

  • Ann Borders
  • Shelly Tien
  • Kai Tao
  • Steve Locher

Webinars

Past Webinars

Wave 1

April 9, 2018: Immediate Postpartum LARC Initiative Wave 1 Launch Call

May 14, 2018: Getting Started with IPLARC

June 18, 2018: Toolkit Overview and First Steps for QI Work

July 16, 2018: Billing/Coding

REDCap Data Entry Training Call – access a recording of the call here.

August 20, 2018: Stocking IPLARC

September 17, 2018: Protocols and Checklists

October 15, 2018: Standardizing Comprehensive Contraceptive Counseling (Prenatal & Delivery Admission)

November 19, 2018: Provider and Nurse Education

December 17, 2018: IT/EMR and Engaging Outpatient Providers

February 18, 2019: IPLARC Wave 1 Round Robin with GO LIVE updates

March 18, 2019: Communicating launch of IPLARC strategies to roll out GO LIVE with affiliated outpatients prenatal care offices and clinics

April 15, 2019: IPLARC Sustainability for Wave 1 Teams

June 17, 2019: Sustainability: Monitor and Improve Comprehensive Contraceptive Counseling

July 15, 2019: Sustainability: Monitor IPLARC Billing and Coding

August 19, 2019: Sustainability: Ensuring Patients Receive Desired IPLARC

September 16, 2019: Sustainability: New Hire and Ongoing Education

October 21, 2019: Sustainability: Appropriate Patient Follow-up 

November 18, 2019: Sustainability: Check-in with Tennessee

December 16, 2019: Sustainability

Wave 2

April 29, 2019: Immediate Postpartum LARC Initiative Wave 2 Launch Call

June 17, 2019: Toolkit Overview and First Steps for QI Work

July 15, 2019: Billing and Coding for Immediate Postpartum LARC

REDCap Data Entry Training Call – access a recording of the call here.

August 19, 2019: Stocking IPLARC

September 16, 2019: IPLARC Protocols and Checklists

October 21, 2019: Comprehensive Contraceptive Counseling 

November 18, 2019: Provider and Nurse Education

December 16, 2019: IT/EMR and Engaging Outpatient Providers

February 17, 2020: Round Robin with Wave 2 Teams

Additional Resources

*New Provider Notice Inpatient Delivery Claims Containing LARC Device Codes (3.19.21) 

Beyond the Pill at UCSF Bixby Center Educational Materials Free Resources: 

Chart showing contraceptive options by tiers of effectiveness, including a graphic showing the chances of an accidental pregnancy. Available formats: laminated chart, tear sheet pad, and poster. Order from here. 

Available in the following languages:

Options for reporting issues with Medicaid MCO billing:

  1. New Mechanism for Handling Issues with Medicaid MCOs- report IPLARC billing issues here.
  2. Report issues with Medicaid MCO claims to ICOY by using this form here.

Review and complete the IPLARC Sustainability Plan with your team and submit to info@ilpqc.org by April 27 to be eligible for an award at the 202 Face-to-Face Meeting.

IPLARC Data Form now LIVE on ILPQC Data System. Paper IPLARC Data Form available here – updated 3/15/19. Sustainability Data Form available here – updated 8/14/19.

IPLARC Billing/Coding Tip Sheet – this document will be updated periodically as new information is learned/becomes available. Please check back often (updated 11/21/19).

IPLARC Fact Sheet – share this document with administrators, providers, and staff!

**NEW RESOURCE** Packet to share with all OB Providers/Outpatient Prenatal Care Sites and Template for Flyer/Draft Letter Announcing IPLARC Go Live! (updated 2/8/19)

IPLARC Grand Rounds Slide Deck – download here! (updated 8/16/2019)

Toolkit

Initiative Resources

  1. 10 Steps to Getting Started with the ILPQC Immediate Postpartum LARC Initiative
  2. IPLARC 7 Key Opportunities for Improvement
  3. 13 Practice Changes for IPLARC Success
  4. Immediate Postpartum LARC Aims and Measures
  5. Immediate Postpartum LARC Data Form
  6. Immediate Postpartum LARC Key Drivers Diagram
  7. Immediate Postpartum LARC Wave 1 Teams Survey
  8. Plan-Do-Study-Act Worksheet
  9. Example Process Flow Diagram (page 7)

National Guidance: ACOG Committee Opinions

  1. ACOG Committee Opinion #670: Immediate Postpartum Long-Acting Reversible Contraception
  2. ACOG Practice Bulletin #186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices
  3. ACOG Committee Opinion #735: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices
  4. ACOG Committee Opinion #672: Clinical Challenges of Long-Acting Reversible Contraceptive Methods
  5. ACOG Committee Opinion #642: Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy
  6. AJOG article: Policy change is not enough: engaging provider champions on immediate postpartum contraception
  7. ACOG Position Statement: Restrictions to Comprehensive Reproductive Health Care

Documentation of IPLARC placement in IT/EMR systems

  1. Example dot phrase/procedure note for immediate postpartum IUD insertion
  2. Example dot phrase for Nexplanon insertion
  3. Example procedure note for Nexplanon insertion (page 20)
  4. Slide Set: Example of Cerner EMR revisions for tracking and documentation of IPLARC
  5. Example Epic Dot Phrases *NEW*

Coding/ billing strategies for reimbursement of IPLARC

  1. Illinois HFS guidance on hospital billing and reimbursement for IPLARC – A printable PDF version of the announcement is available here
  2. A Quick Guide to Reimbursement: Coding for LARC
  3. ICD-10 Codes for Inpatient LARC Billing (page 14)
  4. Illinois Association of Medicaid Health Plans: Medical Director Contact Information to troubleshoot if IPLARC claims not being reimbursed
  5. BCBS Contact Information for Eligibility and Benefits
  6. Aetna Contact Information for Eligibility and Benefits
  7. United Healthcare Eligibility and Benefits

IPLARC devices stocked in inpatient inventory

  1. ACOG District II: Stocking and Supply (page 3)
  2. 340B Drug Pricing Program
  3. Supply Kit for Nexplanon *NEW*

Example protocols for IPLARC placement for labor and delivery and postpartum units.

Referral strategies for providing Immediate Post-Discharge LARC (interval LARC).

  1. Make Referrals Easy – Tool #21 – AHRQ Health Literacy Universal Precautions Toolkit
  2. Patient Referral Checklist

Provider & nurse education on IPLARC evidence, protocols, and counseling

  1. ILPQC/ACOG Immediate Postpartum LARC Training Workshop Dates
  2. Patient Centered Counseling Approaches
    1. Contraceptive Counseling Model: A 5-Step Client-Centered Approach
    2. CDC: Improving Contraceptive Access: Tools for Providers
    3. ACOG LARC Provider Education Video Series: LARC Counseling Scenarios
    4. Patient Education and Counseling from Florida Perinatal Quality Collaborative
    5. LARC Statement of Principles by SisterSong and the National Women’s Health Network
    6. Quality Comprehensive Contraceptive Counseling – A Client-Centered Conversation eLearning – *NEW*
  3. Immediate Postpartum LARC General Education/Support for Nurses & Providers
    1. ACOG LARC Program website and Helpdesk – submit all LARC questions and get response
    2. ACOG Postpartum Contraceptive Access Initiative – online provider resource for IPLARC from ACOG
    3. Immediate Postpartum IUD Expulsion Fact Sheet
    4. Dispelling Long-Acting Reversible Contraception (LARC) Myths and Misperceptions Fact Sheet
    5. ACOG District II Administrative and Infrastructure Support Checklist
  4. Nursing Education
    1. Postpartum LARC: Nursing Education, from Advocate Illinois Masonic Medical Center
    2. Article: What Nurses need to know about immediate postpartum LARC
    3. Immediate Postpartum IUD Education for Nurses, from the University of Chicago
  5. Immediate Postpartum LARC insertion
    1. ACOG LARC Provider Education Video Series – Immediate Postpartum Period, Implant Informed Consent and Pre-Insertion Counseling, Contraindications to Intrauterine Contraception, Contraceptive Counseling and Shared Decision Making Framework
    2. ACOG District II LARC videos for physicians – Immediate Post-Placental LARC Insertion
    3. Two techniques of postplacental IUD insertion and proper location of IUD after insertion
    4. Provider and Staff Training on Clinical Procedures from Florida Perinatal Quality Collaborative
    5. Postpartum IUD Insertion Training

Patient education materials for affiliated prenatal care sites & during delivery admission

  1. Comprehensive Contraceptive Counseling Materials
    1. Bedsider patient education brochure / poster on all contraceptive options and efficacy rates
    2. CDC downloadable patient handout on contraception options
    3. FPQC patient counseling resource
  2. Contraception Materials that Address IPLARC
    1. ACOG FAQ 500: Using Long-Acting Reversible Contraception Right After Childbirth
    2. Postpartum LARC trifold brochure
    3. Post-placental IUD insertion patient hand out
    4. Family Planning After Your New Baby brochure
    5. Immediate Postpartum Intrauterine Device Info Sheet (page 35-36)
    6. Postpartum Contraceptive Implant Info Sheet (page 34)
    7. IPLARC Patient Education Materials from Florida Perinatal Quality Collaborative

Other IPLARC Tookits/Resources

  1. Florida Perinatal Quality Collaborative Access LARC Toolkit
  2. South Carolina Toolkit
  3. ACOG LARC Program
  4. Postpartum Contraceptive Access Initiative

**Key Resource
The following material is an example only and not meant to be prescriptive. The resources provided in this toolkit are for informational purposes only. The exclusion of a resource, program, or website does not reflect the quality of that resource, program or website. Note: websites and URLs are subject to change.