Reintegration of Public Health and Healthcare
Virginia Plan First: Reducing Unintended Pregnancy While Increasing Revenue
Integrating public health and primary care can both improve quality of care for a population and lower
health costs. Both components of the health system share a common goal of health improvement, have
similar funding streams and resources, and share many partnerships. If aligned, public health and primary
care working together could achieve lasting, substantial improvements in individual and population health in
the United States. State and territorial health agencies can make a significant impact in this area by
decoding the key elements for successful integration, which can then be shared with others to promote
further integration efforts, increase healthcare quality, lower costs, and improve overall population health.
Through a coordinated multi-agency effort involving former Virginia Health Commissioner Karen
Remley, Gov. Bob McDonnell, the Virginia Department of Health (VDH), and the state Department of
Social Services (VDSS), Virginia has made strides toward reducing unintended pregnancy rates across the
state by dramatically increasing enrollment in its Medicaid-funded comprehensive family planning
program.
BACKGROUND
Virginia’s Medicaid program is housed in VDSS, which is a separate agency from VDH. A Medicaid
program called Plan First provides a wide range of education and support services, including family
planning exams for women, birth control, and STD testing and counseling for men and women. State
residents with incomes of no more than 200 percent of the poverty level are eligible to receive all Plan
First services without a co-pay. Before the integration effort, Plan First was underutilized; in January
2011, only 6,209 people were enrolled. To better understand barriers to Plan First utilization and then
map out an action plan, VDH assembled representatives from VDSS and key divisions within VDH,
including representatives from some local health districts (LHDs). The group identified numerous
barriers, including: (1) lack of provider and client familiarity with the program, and (2) the paper-based
application and enrollment procedures, which often resulted in missing filing deadlines.
OVERVIEW OF THE INTEGRATION EFFORT
Aim of the Integration:
The integration effort focused on the addressing the key barriers to
participating in Plan First. McDonnell and Remley selected Plan First to be
Reduce unintended
part of a quality improvement initiative, and provided a one-time
pregnancies by increasing
allocation of $400,000 for program planning and coordination. The allotted
utilization of Plan First, a
funds have been used for staffing and activities dedicated to increasing
comprehensive family
enrollment, including training, presentations, developing new outreach
planning program offered
and marketing materials, and ongoing internal collaboration with system
through Medicaid.
partners. One full-time staff member coordinates statewide referral
efforts. She works with LHDs to increase provider participation and
referrals from other organizations. A second part-time staff member works
directly with the LHDs to increase enrollment in the program by providing on-site training and support
to local health clinics and facilitating necessary linkages with local VDSS offices.
RESULTS/BENEFITS
© Association of State and Territorial Health Officials 2013
(202) 371-9090
2231 Crystal Drive, Ste 450, Arlington, VA
www.astho.org
Reintegration of Public Health and Healthcare
As a result of the collaboration between VDH, VDSS, and state officials, Plan First enrollment has
increased from 6,209 participants in January 2011 to 33,254 as of Nov. 1, 2012—reducing unintended
pregnancies among participants while increasing revenue for the state. Initial analysis of pregnancy
rates for program participants found 5.09 per 1,000 relative to 12.9 per 1,000 for non-participants in the
state. Additionally, increased enrollment has allowed VDH to generate more than $1 million in
additional Medicaid billing.
INFRASTRUCTURE TO SUPPORT COLLABORATION AND SUSTAINABILITY
To track progress over time, data have been collected from LHDs and the Virginia Department of
Medical Assistance Services on application completion rates, program enrollment (by gender), teen
pregnancy rates, and revenue. Data are posted centrally each month on the state’s new dashboard,
where LHDs across the state can compare and contrast their performance on the range of indicators.
This has helped to identify specific bottlenecks and ongoing challenges regarding referrals and timely
eligibility determinations.
With the ACA’s implementation, Plan First will be reduced dramatically as more people begin purchasing
insurance through the state health exchanges, and the Medicaid waiver reduces down from 200 percent
and below the federal poverty level to 100 percent. However, VDH’s dashboard has promoted positive
competition between jurisdictions to improve their performance. To further increase enrollment, state
officials are looking at ways to automate much of the current paper-heavy application process to
expedite enrollments, decrease claim denials, and expand the number of providers willing to serve Plan
First enrollees.
For more information, contact :
Joshua Czarda, JD
Performance Improvement Manager
Virginia Department of Health
109 Governor Street, 13th Floor
Richmond, Virginia 23219
Office: (804) 864-7014
Cell: (804) 615-7444
Fax: (804) 864-7023
[email protected]
Karl Ensign
Director, Evaluation
ASTHO
[email protected]
© Association of State and Territorial Health Officials 2013
(202) 371-9090
2231 Crystal Drive, Ste 450, Arlington, VA
www.astho.org