When two women first planned the Illinois Contraceptive Access Now (ICAN!) project in 2020, they were unaware of all the changes that would occur on the reproductive healthcare front over the next several years.
“With millions of women and people who could become pregnant being recently denied the right to body autonomy, it’s never been more important that they can easily obtain the birth control method of their choice,” says Katie Thiede, executive director and co-founder of ICAN! in Chicago. “We had the opportunity to spend the better part of 2020 really planning for this statewide effort to expand contraception access. We were fortunate to have generous support from a funder who recognized there were profound reproductive health disparities in Illinois.”
Thiede teamed up with Kai Tao, ND, MPH, FACNM, a principal and co-founder of Impacting Innovation for ICAN!, to create the initiative, confident they were in a good state for making change.
“Illinois has been a great leader in progressing health and reproductive rights, but the state was facing persistent and worsening disparities in reproductive outcomes,” Thiede explains. “Hundreds of thousands of people were facing persistent barriers to accessing high-quality contraceptive care.”
As they dug deeper into data, they realized that the people falling between the cracks were those who were uninsured because they did not qualify for public benefits or they were unable to use their health insurance for contraception due to privacy concerns, such as underage girls and people experiencing intimate partner violence.
“Some fall into the gap despite having commercial coverage because their plan might be grandfathered and not include the [Affordable Care Act] contraception expansion, or their plan operates under a religious directive,” Thiede says. “That’s why one of our strategic directives was to advance policies that would expand coverage for contraceptive care, which we have done. We [helped] pass legislation that made it possible.”
Expanding Access
ICAN! focuses on expanding contraception access beyond what can happen if Title X programs are more fully funded because it works on training non-Title X providers to also offer quality contraceptive care.
“Any large public health issue requires a multipronged approach, and you have to look at your assets and resources in your state,” Tao explains. “We know Title X is long-standing and has dedicated family planning dollars, and it was started over 50 years ago.”
But the reality of birth control is that it should be basic healthcare that any primary care provider — including pediatricians, family physicians, and others — should provide. “It should be normalized into normal family healthcare,” Tao says. “ICAN! is focused on making sure it is routine in primary care visits, and we work primarily with primary care providers in healthcare settings.”
The timing works out well. States with access to abortion care, including Illinois, are inundated with people traveling from other states. It has energized physicians and staff in primary care settings.
“We know a lot of providers and staff feel like they want to do something because of what’s happened since the fall of Roe,” Tao says. “Changing how you practice takes time, and it takes continuous efforts.”
So far, 1,000 Illinois providers have trained through ICAN!, and 11 community healthcare organizations across the state have joined the project. This means that many more women could obtain any birth control method they want at no or low cost on the same day.
Trained primary care providers also offer quality contraceptive care to out-of-state patients, but only Illinois residents have access to special state funding for the care. “We work with providers at community health centers and work with payers, including Medicaid insurance and managed care,” Tao says. “We work with patients, engaging them to help them exercise their right to reproductive autonomy.”
The program is unique in how it offers help to everyone for comprehensive contraceptive care. “Ours is unique because many other programs across the nation have the same mission but are often the payer of last resort,” Tao explains. “We were intentional that ICAN! is not a payer or an insurance program.”
Access to Contraception for All
By working with safety net providers like Federally Qualified Health Centers, ICAN! ensures that patients receive affordable or free contraceptive care in the clinic where they already receive care for other issues.
Everyone — including people who are undocumented — can receive quality contraceptive care at the clinics where the program has trained clinicians and taught staff how to access the benefits of the Illinois Department of Healthcare and Family Services (HFS) Family Planning Program.
“We plan to expand the network through the next several years,” Thiede says. “We have been able to evolve how we share training assistance and best practices with providers.”
Training Opportunities
For example, there is a learning series ICAN! hosts with healthcare provider partners. “We’ve included training in ways for healthcare partners to optimize and implement the HFS Family Planning Program,” Thiede adds. “We make sure they have the right workflows in place and that they know this coverage exists.”
They help centers with enrolling patients in the program and improving their billing and reimbursement.
A foundational, 70-minute webinar features modern birth control and reproductive justice.1 “We work with seasoned OB/GYNs, and they bring this video to life,” Tao says. “There’s a learning series that can be monthly or bi-monthly, and it has hour-long topics on reproductive access and quality.”
It also is a peer-to-peer learning opportunity, and healthcare leaders can be a part of it. For example, one peer-led session could be on billing and another on same-day provision of contraception. The gold standard is providing the contraception they want on the same day, Tao says.
Another learning series is about how to operationalize same-day contraceptives. It includes information about storing the products, billing, and keeping inventory.
“There are operational pearls and insights and sharing,” Tao explains. “One person could say, ‘This healthcare center does it this way. Why don’t we do it that way?’”
An inventory change that seems impossible becomes possible when leaders and providers learn about the experiences of other healthcare providers who faced similar circumstances.
“There have been a number of positive learning series we’ve done,” Thiede says. “Some examples are how to routinely screen your patients for their contraceptive needs and desires.”
The classes provide tips on how to initiate conversations about sexual health and provide a person-centered approach to counseling patients.
“We’ve done training on coding practices amongst providers,” Thiede adds. “We curate topics that we know are really important to quality and access, and we also listen to healthcare partners about what they most need to move things forward.”
REFERENCE
- ICAN!. What is ICAN!? 2023.
ICAN! focuses on expanding contraception access beyond what can happen if Title X programs are more fully funded because it works on training non-Title X providers to also offer quality contraceptive care.
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