Family PACT (Planning, Access, Care and Treatment) Program Evaluation

INTRODUCTION

HIGHLIGHTS

INTRODUCTION

Since 1997, the Bixby Center has provided program support and evaluation for the Family PACT (Planning, Access, Care and Treatment) Program, California’s publicly funded family planning program. The overall goal of Family PACT is to promote optimal reproductive health and reduce unintended pregnancy by increasing access to comprehensive family planning services for low-income Californians. Annually, Family PACT serves more than 1.8 million low-income women, men, and adolescents.  The program, which is administered by the California Department of Health Care Services’ Office of Family Planning (DHCS-OFP), was established by the California legislature in 1996, and implemented in 1997. Between December 1999 and July 2010, the State received additional funding for the program from the federal government through a Centers for Medicare and Medicaid Services (CMS) Section 1115 Demonstration Waiver.  Evaluation analyses provided by the Bixby Center assisted the State in demonstrating Family PACT’s positive impact on cost-saving and health outcomes over the waiver period.  In March 2011, the federal government approved California’s application for a State Plan Amendment, formally integrating Family PACT into the Medi-Cal State Plan.

The Bixby Center conducts an annual analysis of key program metrics of the Family PACT Program. The data analyzed are derived from enrollment and claims data and describe provider and client populations, the types of services utilized, fiscal issues, and county profiles. For the FY 2009-2010 Annual Report, click here. Using a multi-method evaluation approach, the Bixby Center conducts evaluation of the program using additional data sources to assess, among other things, the quality of clinical care, adherence to program standards, provider referral practices, the cost-benefit of the services, and the level to which women who need publicly-funded family planning services access the program. Findings from these evaluations are reported in study-specific reports, policy briefs, and research summaries.

For a complete list of Family PACT factsheets, briefs, reports and journal articles see: http://bixbycenter.ucsf.edu/publications/internal.html#FamilyPACT  

These findings inform Family PACT’s quality improvement, utilization management, and provider education activities, all of which help to ensure that clients receive high quality clinical services. The Bixby Center evaluation team also partners with the California Department of Public Health’s STD Control Branch to monitor sexually transmitted infection services and to develop clinical practice guidelines and provider education programs.

HIGHLIGHTS FROM FAMILY PACT EVALUATION STUDIES 

• The 2007-2009 Birth Rates by County Among Teens and Low-Income Adult Women in California report presents findings on the associations between access to publicly funded family planning services and birth rates among teens age 15-19 and low-income adult women age 20-44 at the county level. This supplements the Access to Publicly Funded Family Planning Services, Fiscal Year (FY) 2006-2007 report and results indicate that substantial variations exist across California counties and among the Service Planning Areas (SPAs) in Los Angeles; eight counties in particular emerged as potential target areas to where improvement in access to publicly funded family planning services can be directed. 
• The 2008-2010 Male Involvement Report examines the association of California women’s perceptions of their partners’ involvement in contraceptive decision-making and utilization with socio-demographic characteristics and women’s current contraceptive use. This report utilizes three year data from the CWHS and includes descriptive and chi-square analyses assessing male partners’ involvement. Contraceptive prevalence rates were found to be highest among women who reported a high degree of shared involvement compared to women without any partner involvement. Conversely, the proportion of contraceptive nonusers was highest among those without partner involvement and lowest among women with a high degree of involvement. 
• The 2007 Medical Record Review Report presents findings on clinical quality and client outcomes derived from a retrospective review of medical charts obtained across a representative sample of 201 Family PACT providers and 4,136 Family PACT clients.  The report presents findings on a wide scope of topics related to the quality of clinical patient care within Family PACT, provider adherence to Family PACT Program Standards, descriptive details on provider types, and changes over time. Highlights of the report include analyses on contraceptive utilization by clients with a special focus on intrauterine contraception, pregnancy testing and follow-up, risk assessment for sexually transmitted infections with a special focus on Chlamydia screening and treatment,  and service provision to clients with limited English proficiency.  Findings from the study indicate that in general, Family PACT providers are delivering services consistent with the program standards and most, but not all, quality indicators improved over time. Differences are noted by provider sector and specialty.  The report identifies opportunities for improvement such as improving the quality of documentation, facilitating the provision of high efficacy contraception, improving the quality of medical records and documentation, and facilitating better follow-through on referrals.
• The 2007 Cost-Benefit Analysis - A Brief found that the Family PACT Program averted an estimated 296,200 unintended pregnancies in California. By reducing public health and welfare expenditures resulting from unintended pregnancies, every dollar spent on Family PACT saved the public sector $4.30 from conception to age two and $9.25 from conception to age five (Read the full report)

OPA COOPERATIVE AGREEMENT GRANT

As part of a Family Planning Research Cooperative agreement with the Office of Population Affairs, the Bixby Center analyzes Family PACT claims data and provider survey data from Title X and non-Title X Family PACT providers. Three briefs, Providing Access to Family Planning through Title X and Medicaid Family Planning, Family Planning Provider Education and Training in California, and Chlamydia Screening in the Family PACT Program have been written. The first two compare Title X and non-Title X Family PACT providers with the first describing provider/client characteristics and client access to services and the second describing training opportunities available to providers. The third describes chlamydia screening rates in the Family PACT program.

HIGHLIGHTS FROM 2013-14 JOURNAL ARTICLES

Association of Access to Publicly Funded Family Planning Services with Teen Birth Rates in California Counties. This article examined the association of adolescent birthrates (ABRs) with access to and receipt of publicly funded family planning services in California counties. Linear regression analysis indicated that a higher access rate to Family PACT in a county was associated with a lower ABR when controlling for unemployment rate, percentage of foreign-born adolescents, and percentage of adult low-income births. Family PACT played a crucial role in helping California adolescents avoid unintended and early childbearing. 

Postpartum Contraception in Publicly-Funded Programs and Interpregnancy Intervals showed that a significant association between receiving contraception through Medi-Cal or Family PACT with avoiding short interpregnancy intervals. Receiving contraception at the first postpartum clinic visit had an additional independent effect on avoiding short interpregnancy intervals when controlling for the other variables. 

Intrauterine Contraception: Impact of Provider Training on Participant Knowledge and Provision discusses the evaluation of the impact of skills based IUC insertion training on clinician knowledge of the broad range of appropriate IUC candidates and measure changes in IUC provision following training.  Training participants increased their understanding of appropriate candidates from 58% to 81%.  Sites that participated in the training provided more women with IUC following training.

Cost-Savings from the Provision of Specific Contraceptive Methods in 2009. Every contraceptive method studied saved more in public funds for unintended pregnancy than it costs to provide. IUC and contraceptive implants had the highest cost savings with approximately $5.00 of savings for every dollar spent for users of these methods.