In 2016, the National Quality Forum (NQF) endorsed three contraceptive care quality measures to assess the degree to which women access effective methods of contraception. This endorsement is an important milestone in quality measure development for family planning services, providing for the first time an evaluation metric on availability and use of effective contraception. Beginning with the 2017 measurement year, the Centers for Medicare & Medicaid Services (CMS) has incorporated two of the three contraceptive care quality measures into its core Medicaid measure sets for adults and children. At the same time, states are incorporating the measures into Medicaid valuebased payment (VBP) models, or payment models that reward providers for improving access and outcomes and lowering costs.
As Medicaid programs consider use of contraceptive care quality measures, including with respect to VBP program incentives, Medicaid policymakers and their plan and provider partners must be vigilant in ensuring women's agency in their contraceptive choices.1 (See Figure 1 for further details.) This vigilance is critical in light of the preference-based decision of contraceptive use and the history of coercive practices limiting women's contraceptive choices and even the decision of whether to become pregnant. These practices generally targeted women with low incomes, immigrants, and women of color and included sterilizing without consent and conditioning release from prison or access to food assistance and other social service programs on the use of longacting reversible contraceptives (LARC). Studies suggest that these practices persist, potentially causing distrust of the medical establishment among some women. 2, 3, 4
This brief discusses the benefits of measuring contraceptive care quality and describes guardrails that state policymakers and Medicaid managed care organizations (MMCOs) will want to consider to ensure that measurement of contraceptive care quality does not inadvertently incentivize providers or MMCOs to coerce women into the use of contraception or specific types of contraception.