Contraceptive Care Measures

The contraceptive care measures use claims data and are intended to encourage providers to screen for pregnancy preferences, offer the full range of most and moderately effective contraceptive methods, and use a client-centered approach to contraceptive counseling. The measures align with clinical guidelines that promote the provision of contraception in a safe, effective, and client-centered way.

Limitations of Claims Data

Administrative claims data have some limitations when used to assess the quality of contraceptive care. One key limitation is that claims data do not capture several aspects of people’s risk of unintended pregnancy: sexual experience, pregnancy intention, sterilization, LARC insertion in the year before the measurement year, and infertility for non-contraceptive reasons (unless the woman had a sterilization procedure during the measurement year). These limitations can be partly addressed by using data from the National Survey of Family Growth to help interpret the performance measure rates for the provision of most and moderately effective methods of contraception.

Learn more about interpreting rates for the contraceptive care measures.

Related Contraceptive Care Measures

The Person-Centered Contraceptive Counseling (PCCC) measure, which is stewarded by the University of California, San Francisco, is a person-reported outcome performance measure that evaluates the person-centeredness of contraceptive counseling. The PCCC scale summarizes three domains of contraceptive counseling: (1) interpersonal connection, (2) adequate information, and (3) decision support. To measure these three domains, surveys are administered to people immediately after a contraceptive counseling visit. CMS’ consensus-based entity (CBE) endorsed the PCCC measure in 2020 (CBE #3543).

In addition, OPA helped fund the development of two electronic clinical quality measures (eCQMs) to assess the percentage of people who receive contraceptive services that wanted them. Unlike the claims-based measures, the eCQMs focus on people who are interested in contraceptive services. Both measures were endorsed by CMS’ CBE for trial use in December 2022. The postpartum eCQM assesses the percentage of people who (1) received or had documented use of most or moderately effective contraception during the postpartum period and (2) received a LARC during the postpartum period (CBE #3682e). The non-postpartum eCQM assesses the percentage of people who wanted contraceptive services that: (1) received or had documented use of most or moderately effective contraception and (2) received a LARC during the calendar year (CBE #3699e). Both eCQMs focus on people who indicated a desire for contraception; those who did not indicate such a desire were excluded from the measures.

Clinical Guidelines

Clinical practice guidelines, or “clinical guidelines,” are consensus- or evidence-based statements that include recommendations to help clinicians (1) make decisions during specific clinical circumstances and (2) optimize patient care.⁷ The contraceptive care measures are informed by the following clinical guidelines, among others:

• Updated Recommendations on Contraception and Adolescents | American Academy of Pediatrics (2020)
• Access to Contraception, Committee Opinion #615 | American College of Obstetricians and Gynecologists (ACOG) (2015, Reaffirmed 2022)
• Improving Access to Intrauterine Devices and Contraceptive Implants, Committee Opinion #736 | ACOG (2023)
• Optimizing Postpartum Care, Committee Opinion #736 | ACOG (2018, Reaffirmed 2021)
• Patient-Centered Contraceptive Counseling, Committee Statement # 1 | ACOG (2022)
• Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate | Centers for Disease Control and Prevention (CDC) (2021)
• Providing Quality Family-Planning Services | CDC and OPA (2017)
• United States Medical Eligibility Criteria for Contraceptive Use | CDC and OPA (2016)

CCW: Contraceptive Care All Women measure.
CCP: Contraceptive Care Postpartum Women measure.

Footnotes

¹ Update to the Women’s Preventive Services Guidelines. (2022, January 12). Federal Register. https://www.federalregister.gov/documents/2022/01/12/2022-00465/update-to-the-womens-preventive-services-guidelines ^{back to top}

² American College of Obstetricians and Gynecologists. (2015). Access to contraception (Committee Opinion Number 615). https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2015/01/access-to-contraception ^{back to top}

³ Moniz, M. H., Gavin, L.E., & Dalton, V.K. (2017). Performance measures for contraceptive care: A new tool to enhance access to contraception. Obstetrics & Gynecology, 130(5), 1121–1125 doi:10.1097/AOG.0000000000002314. ^{back to top}

⁴ Zapata, L. B., Pazol, K., Curtis, K. M., Kane, D. J., Jatlaoui, T. C., Folger, S. G., Okoroh, E. M., Cox, S., & Whiteman, M. K. (2021). Need for contraceptive services among women of reproductive age — 45 jurisdictions, United States, 2017–2019 (Morbidity and Mortality Weekly Report, Vol. 70). U.S. Department of Health & Human Services, Centers for Disease Control and Prevention. ^{back to top}

⁵ Lindberg, L. D., VandeVusse, A., Mueller, J., & Kirstein, M. (2020). Early impacts of the COVID-19 pandemic: Findings from the 2020 Guttmacher Survey of Reproductive Health Experiences. Guttmacher Institute. https://www.guttmacher.org/report/early-impacts-covid-19-pandemic-findings-2020-guttmacher-survey-reproductive-health ^{back to top}

⁶ Sutton, M. Y., Anachebe, N. F., Lee, R., & Skanes, H. (2021). Racial and ethnic disparities in reproductive health services and outcomes. Obstetrics & Gynecology, 137(2), 225–233 doi:10.1097/AOG.0000000000004224. ^{back to top}

⁷ Institute of Medicine (US) Committee to Advise the Public Health Service on Clinical Practice Guidelines, Field, M. J., & Lohr, K. N. (Eds.). (1990). Clinical Practice Guidelines: Directions for a New Program. National Academies Press (US). ^{back to top}