Annual Report Fiscal Year 2021:

This section provides a summary of FFY21 activities, accomplishments, and challenges related to NPMs and SPMs (2021-2025) for the Women/Maternal Health Domain.

Access to quality reproductive health services can be difficult to find in rural and frontier areas. FQHCs and RHCs play a vital role in contraceptive access, providing services to a large number of Wyoming women of reproductive age. While many states across the country saw a reduction in Title X clinics and services in the past few years, Wyoming saw increased Title X funding and the ability to partner to improve training and access to LARC services in the outpatient setting.

Unfortunately, provider training on LARC insertions in the outpatient setting were put on hold due to the COVID-19 pandemic. The entire nation saw the pandemic’s impacts on reproductive health services as clinics shut down and quickly changed protocols in order to provide limited hours or telehealth services. In Wyoming, some clinics did find that doing contraceptive screenings via telehealth improved retention rates for LARC insertions. Telehealth services provided new protocols on how patients are screened to receive the contraceptive of their choice and improved secondary visits for LARC insertions. (It is common practice that a LARC cannot be inserted in an outpatient setting without a separate screening appointment, so the LARC is then inserted at the second medical encounter.)

Strategy 1

Develop culturally appropriate communication campaign(s) on the importance of a well woman visit.

In FFY21, the WIHP released a RFP to conduct focus groups. During the summer of 2021, the OMNI Institute was selected to conduct virtual focus groups in both English and Spanish across the state to better understand the knowledge of, and the barriers to, attending a well woman visit. The contract was executed in FFY21 and ended in FFY22.

The WIHP provided guidance and support for the content creation regarding well woman visits in the My 307 Wellness App. This application provides a “learn library” for users to seek out information related to health and lifestyle questions they may have. Content around the importance of the well woman visit was added alongside a “well woman exam to-do” that users can cross off when their annual visit is completed. From October 2020 to September 2021, 160 women aged 18-44 enrolled in the My 307 Wellness App. Of those 160 women, 9 women checked off the “to-do” for the well woman exam. The percentage of women who interacted with messaging regarding the well woman visit was 5.6%.

In June of FFY21, the WIHP contracted with the WYPCA to provide training on LARC outpatient insertions for clinicians, provide a series of trainings on shared decision-making during well woman visits and a postpartum follow-up visits, assist in the creation of provider training materials on well woman visits and LARC, and translating the most recent draft of a LARC toolkit (created in a previous contract with the WYPCA) into a digital and downloadable resource for providers. The WYPCA coordinated monthly stakeholder meetings to review training materials and discuss updates to the content in the LARC toolkit. During FFY21, Medicaid approved the unbundling of immediate postpartum LARCs. This will help to ensure that postpartum women will have prompt access to the LARC of their choosing, without having to wait and return to an outpatient office setting to receive one. This also ensures that their LARC is covered by Medicaid in a timely manner and will be a separate code from labor and delivery services. Since the policy went into effect, WY MCH shifted effort toward the 2021-2025 priorities and action plan implementation.

Strategy 2

Work with Medicaid, the BHD, and other partners to conduct a gap analysis and map of the current mental health infrastructure for women of reproductive age in Wyoming.

In FFY21, due to the ongoing COVID-19 pandemic and the lack of partnership with the BHD, a gap analysis and map of the current mental health infrastructure for women of reproductive age in Wyoming was not completed. The WIHP Manager worked to improve the relationship between WY MCH and BHD to ensure partnership in the future. Collaborations with Medicaid continued, but were not focused on mental health of reproductive-aged women.

In FFY21, the WIHP partnered with Medicaid on their Postpartum Care Affinity project. The goal of this project was to increase postpartum visits among the Wyoming population who are on Wyoming Medicaid. Within this partnership, the WIHP has provided guidance on the creation of activities and materials to reach pregnant people on Medicaid. Specifically, the WIHP created an infographic displaying information on postpartum visit recommendations by the American College of Obstetricians and Gynecologists. This infographic was posted on Wyoming Medicaid’s social media and distributed across Wyoming Medicaid Newsletters.

Strategy 3

Stand up a joint state Maternal Mortality Review Committee with the Utah Department of Health and develop Wyoming specific protocols.

In FFY21, the WIHP, as part of the Wyoming Department of Health partnered with the Utah Department of Health for the Wyoming MMRC Partnership grant. This partnership created a joint, cross-state Utah-Wyoming Maternal Mortality Review Committee, in which the Wyoming Department of Health shares non-identifiable case summaries of pregnancy-associated deaths in Wyoming to the Utah Department of Health for evaluation. In FFY21, Wyoming’s first MMRC case review was held, with Wyoming receiving good feedback on the review, and the WIHP made an agreement with the Utah Department of Health to hold four Wyoming reviews per year instead of two per year as initially agreed upon. In FFY21, case reviews had begun for the years 2018-2020. In February of 2021, WY MCH renewed the contract for abstractor services with the University of Wyoming Fay W. Whitney School of Nursing case abstractor. In April of 2021, a Laramie, Wyoming based OB/GYN and a PHN regional coordinator were onboarded to the Wyoming team and participated in their first case review. A new family practice physician was recruited and onboarded to the Wyoming team in May 2021.

A majority of the Wyoming team attended the Maternal Mortality Review Information Application User Meeting, held virtually in April 2021. The team met with Utah to further discuss how to conduct family interviews as part of the case abstraction process. Both states’ teams will also begin to look at the Iowa model of bringing on lived experience to the WyPQC to assist with moving recommendations from the review committee forward.

In FFY21, the WyPQC held one meeting in February of 2021. This meeting introduced an e-learning implicit bias course from the March of Dimes, titled “Breaking Through Implicit Bias in Maternal Healthcare,” with the goal of members recruiting hospitals to participate in this course. This course was provided free of cost for participating Wyoming hospitals, as funding was allocated from WY MCH’s partnership with the Utah Department of Health in their Alliance for Innovation on Maternal Health (AIM) Obstetric Care for Women with Opioid Use Disorder Safety Bundle.

Annual Report Fiscal Year 2021 Supplement:

This section provides an interim update for FFY22 activities currently in process for the WIHP.

Well Woman Visits and LARC

Activities and strategies on LARCs in Wyoming are finished, with no new objectives or strategies to be implemented for the new cycle. The 2021-2025 Title V priorities have now switched to focus on the promotion of well woman visits. It was decided that the LARC work, while important, did not actively impact our NPM of increasing the percentage of women ages 18-44 with a preventive medical visit in the past year. Focusing on work that actually promotes the well woman visit will not only increase LARC usage, but also improve screening and prevention of multiple different health issues. A well woman visit here is described and measured as any preventive annual visit in the last year. This would be a visit to a primary care provider or any medical focused visit, including visits for screenings, general checkups, or informational conversations with a medical provider. Current work for the well woman visit is ongoing, with virtual focus groups in English and Spanish conducted in spring 2022. Results from these will help to inform well woman visit programming and any possible barriers to access to care.

Wyoming Perinatal Quality Collaborative

In FFY22, the WyPQC started the process of revitalization after one year of being inactive due to low capacity from WIHP staff, COVID-19, and lack of funding. A leadership board was created in January 2022, and has met monthly since. One quarterly general membership meeting has been held already, with the next one expected to be held in early summer. Yearly QI projects will be chosen based on the recommendations from the joint UT-WY MMRC. Current WyPQC project topics for FFY22 concern mental health and substance use.

A RFP was released for a WyPQC coordinator in March 2022, and Infield Vector LLC was selected in April 2022. The contract process with Infield Vector LLC is underway, and their work should begin by September 2022. Having a WyPQC coordinator will help increase capacity overall for the WyPQC and will help with outreach to hospitals and other community partners. The WIHP and the WyPQC have applied for the CDC Statewide Perinatal Quality Collaboratives grant program, which will help increase capacity to implement quality improvement initiatives in hospitals. Specifically, if awarded, the WyPQC will work to implement a substance use screening tool in participating hospitals, which will help improve maternal and infant health outcomes. Notice of awards for this grant are expected by September 2022.