Long Acting Reversible Contraceptives, or LARCs, are considered the most effective method of reversible contraceptive by medical experts across the spectrum. Fewer than 1 in 100 women using an IUD or contraceptive implant will get pregnant within one year, compared to 9 out of 100 using the birth control pill.
Given the personal, social and financial toll unintended pregnancies can have and the relatively small percentage of women who take advantage of LARCs (they account for only 7.2% of women who use contraception nationally), the South Carolina Birth Outcomes Initiative saw an opportunity to expand the use of LARCs by offering them in the immediate postpartum period before a new mother is discharged from the hospital.
As a result of their efforts, in 2012 South Carolina became the first state to institute a Medicaid policy enabling hospitals and providers to receive full reimbursement for a LARC device and insertion when a woman received it postpartum. This lowered the barrier considerably for new mothers on Medicaid to choose more effective methods of contraception, but simply changing the policy was only the beginning. Hospitals needed time and resources to implement new procedures to make LARC counseling and insertion a seamless part of existing processes.
Since 2012, five birthing hospitals have begun offering inpatient LARCs as part of their postpartum practices, but SC BOI wants to see that number rise to 15 by year end. To achieve that goal, the group collaborated with the Choose Well Initiative to create the South Carolina Postpartum LARC Toolkit, a comprehensive resource for hospitals looking to implement the Medicaid policy.
Built with the assistance of physicians from Palmetto Health, Greenville Health System and Spartanburg Regional Healthcare System, the toolkit makes a strong case for the importance of LARCs and provides a step-by-step guide for how to enact the policy. The three health systems suggest roughly a six-month timeline which will vary depending on system complexity, changes in billing processes and training needs. The first step is building administrative support and infrastructure to make sure reimbursement procedures are in place and administrators have approved plans to move forward. Next comes developing clinical support with nurses and physicians, which will involve building a consensus around the value and appropriateness of the procedure and creating a set of counseling, consent and insertion procedures that are well-integrated into labor and delivery or postpartum floor practices. Then all clinical staff, including prenatal care providers and lactation consultants, need to be trained with an adjustment period following for improving the process.
The toolkit also includes a bevy of resources to help develop the various procedures and appropriate set of billing codes necessary in the new system. In all, the resource should assist more hospitals implement the Medicaid policy which will lead to better birth outcomes and have a lasting effect on the ability of low-income South Carolinians to plan their families.