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Service Delivery Infrastructure

Title X Sustainability Assessment

In 2016, the Office of Population Affairs (OPA) developed Title X Sustainability Assessment Tools for Grantees and Service Sites in an effort to understand the readiness of the Title X network to respond to the evolving healthcare system in the United States. OPA is using the quantitative data collected through these OMB-approved surveys to develop targeted technical assistance and training resources.

Two separate survey tools assessed Title X grantees and Title X service sites on a range of topics related to sustainability. The grantee is the direct recipient of the Title X grant funding. Service sites receive Title X funds through the grantee and provide Title X services. The 2016 Title X Sustainability Assessment Tool for grantees collected grantee-level data on grantee characteristics, policy, enrollment activities, quality monitoring, and Family Planning Annual Report (FPAR) data collection systems.

The more in-depth 2016 Title X Sustainability Assessment Tool for service sites collected site-level data on site characteristics, enrollment activities, linkages to primary care, electronic health record (EHR) systems, quality improvement efforts,  revenue indicators, and cost analyses.

Key Findings

The response rate was 100 percent across grantees for the grantee survey (89 out of 89 grantees) and 89 percent among service sites for the site survey (3,436 out of 3,861 service sites). The results from preliminary analyses revealed that there was great variability across the Title X network in each of the different domains and helped OPA identify areas where the network is performing well and areas where there is room for improvement.

EHR Systems

As Health IT continues to move rapidly towards a reality in which all providers will have the capability to send and receive health data electronically and OPA works towards revamping the FPAR data collection system, the adoption and use of EHRs is increasingly important for the Title X network. Although anecdotal information suggested that the prevalence of EHR systems would be low, 69 percent of service sites reported that they had already implemented and were using an EHR system and seven percent were in the process of transitioning to an EHR. On the lower end of adoption to implementation continuum, 14 percent of sites indicated they were planning to adopt an EHR system, but had not yet identified a vendor, and only four percent of sites reported that they had no plans to adopt or implement an EHR between May 2015 and May 2017.

Partnering with Private Health Insurance

Title X regulations require that all Title X recipients must seek third-party reimbursement from all public or private sources where there is legal obligation or authorization, and this becomes increasingly important in the current and evolving health care system context. Eighty-four percent of service sites reported they had attempted to contract with private health insurance plans. Of these, 85 percent had been successful in their attempts. Having such partnerships is crucial, as contracts with private health insurance plans can diversify a provider’s revenue streams and open doors for additional sources of revenue.

Enrollment Assistance

Having more clients enrolled in health insurance provides Title X service sites with an increased ability to bill for services rendered and an opportunity to generate greater revenue for clinics. The Title X network assisted over 2 million clients with health insurance enrollment and enrolled more than 1 million clients in a health insurance plan between April 1, 2015 and March 31, 2016.

Revenue Indicators

The average claims denial rate is the percentage of claims submitted by a provider that are denied by health insurance plans. This is important because it quantifies the effectiveness of revenue cycle management processes and can be used by providers to identify specific issues and processes that, once rectified, may improve revenue and cash flow. Among Tile X sites, the average claims denial rate ranged from 3 to 11 percent between payers. This was comparable to the industry average of 5 to 10 percent.  However, less than 5 percent is desirable. The net collection rate is the amount of money collected from health insurance plans compared to the amount of payment that was expected for a given service and measures how successful providers are at collecting money that is due to them. On average, this ranged from 20 to 58 percent between different third-party payers (TPPs). Analyzing such data can help organizations pinpoint and focus on issues that are hindering their ability to maximize reimbursement from TPPs.

Quality Improvement

In November 2016, the National Quality Forum endorsed the first clinical performance measures for contraceptive care. The first of these measures is the percentage of women aged 15 to 33 at risk of unintended pregnancy that is provided a most effective (sterilization, implants, intrauterine devices or systems (IUD/IUS)) or moderately effective (injectables, oral pills, patch, ring, or diaphragm) contraceptive method. It is an intermediate outcome measure because it represents a decision that is made at the end of a clinical encounter about the type of contraceptive method a woman or teen will use, and because of the strong association between type of contraceptive method used and risk of unintended pregnancy. Across Title X service sites, 64 percent of women aged 20 to 44 years and 71 percent of adolescents aged 15 to 19 years were provided a most or moderately effective contraceptive method in 2015. Nationally, the National Survey of Family Growth (NSFG) 2011-2013 reported 63 percent and 43 percent of women and teens, respectively.

Content created by Office of Population Affairs
Content last reviewed on September 20, 2017