Improving Performance Measures by Applying a Sexual and Reproductive Health Equity Lens
By Jamie Hart
Access to contraception has been making headlines recently in the wake of the U.S. Supreme Court’s decision further limiting access to birth control.
In the midst of this continually evolving landscape, CECA maintains its commitment to expanding contraceptive access as part of a broader vision of attaining sexual and reproductive health equity and reproductive quality of life. Last month, CECA convened a virtual technical expert panel (TEP) with 30 participants with diverse perspectives and expertise to examine how performance measures can be implemented to expand access to contraception equitably in communities across the country. Because of CECA’s commitment to applying a sexual and reproductive health lens to our work, we specifically sought to bring this approach to the question of measurement. While the meeting was broad ranging, this blog post focuses on those aspects of the discussion that were most informed by this lens.
Performance measures are tools with the power to drive improvement in the health care industry, inform and empower consumers to ask questions and make the best choices, and drive how providers are paid. They must be specifically designed and implemented with an eye toward equity or can incentivize the continuation of inequitable care. Their application in contraceptive care is still relatively new (the initial set was endorsed in 2016) so we must continually look for ways to improve and monitor these new tools.
CECA’s TEP sessions kicked off with a discussion around key contextual issues surrounding performance measures, their alignment with quality, and their use and potential misuse. Key discussion points included:
Performance measures provide a consistent and accountable approach to assess the delivery of health care against recognized standards.
Early work on contraceptive care performance measures focused on the goals of increasing access to contraceptive methods and to quality, patient-centered contraceptive care.
The stakes are even higher for contraceptive care when considering the potential for performance measures to negatively impact care and exacerbate reproductive injustices.
Patient-centered care should be the standard of care, and this will require transformation of health care systems and norms.
Working against this backdrop, the panel discussed and identified several mechanisms to improve existing and emerging measures. They include:
Defining a more accurate version of pregnancy intention screening to fundamentally set the stage for the rest of the work. In performance measurement terms, this would mean a change in the denominator to one driven by patients’ desires, not by their demographics.
Developing tools and processes to support implementation of multiple measures as a “package” to support both the public health imperative to increase contraceptive access and the imperative to uphold reproductive autonomy and deliver just, person-centered care.
Designing a measure to understand the full breadth of what people want, what services they receive that includes all aspects of reproductive health.
Conducting exploratory work to define and measure reproductive well-being/quality of life.
When the right measures are in place to drive health care improvement, patient care and outcomes can and do improve. CECA appreciates the input of the experts during the TEP to move toward this goal, and will integrate these findings into evidence-based recommendations for future federal executive branch actions. Together, our work to support contraceptive performance measures has the potential to meaningfully expand access to quality contraception, bring contraceptive care up to date with new innovations in health care delivery, and advance progress toward sexual and reproductive health equity.
Click here to learn more about the importance of performance measures.