The Wisconsin Title V program views women and maternal health as part of an ongoing cycle or continuum, including pre-pregnancy, pregnancy, delivery, postpartum, and reintegration into primary care.

Unfortunately, Wisconsin lacks a coordinated system to successfully engage women throughout this continuum, and the Title V program is working to build such a system. This work spans both the Women/Maternal Health population domain, as well as the Infant/Perinatal Health population domain. Reviewing the narratives from both population domains will provide the most detailed account of this work.

National Performance Measure 01: Percent of women with a past year preventive visit

Too few women receive an annual preventive medical visit in Wisconsin. Wisconsin’s Title V program aims to increase the percent of women aged 18 to 44 who have had a preventive visit in the last 12 months from 70.6% in 2020 up to 82.1% by 2025.

Prior strategies from the beginning of this grant period have been difficult to implement due to high staff turnover, a common occurrence during the pandemic, not only with state staff, but also within local health departments and reproductive health family planning clinics. However, prior successes of internal partnerships across Wisconsin’s Bureau of Community Health Promotion and external stakeholders continue to grow. Although there has been a shift in implementation of strategies, the goals have been the same, and new strides are being made each day.

Increase training opportunities and technical support for partners and providers to build awareness of preventive care in reproductive health.

Wisconsin aims to increase awareness, training opportunities, and technical support in 2024 for partners and providers, focusing on building awareness of preventive care services in reproductive health family planning and work toward promoting a permanent medical home for the women/maternal population. This work is especially important since throughout COVID-19, many people put their primary wellness visits on hold.

Local health departments and reproductive health clinics report seeing a rise in client load, and with it, a lack of tools to promote their services including the annual preventative medical visit and importance of a permanent medical home. Local health departments and family planning clinics expressed a need for marketing tools that can be disseminated on social media and a statewide campaign to help increase awareness of the annual preventative visit and permanent medical home, but due to their limited resources and barriers with staff turnover, they are having a difficult time creating tools at the local level.

The Title V program plans to support local health departments and reproductive health clinics in identifying, creating, and disseminating marketing tools for them to use. This will provide cohesive messaging and enable even the smallest of clinics to put out information promoting the importance of the annual wellness visit and a medical home.

Along with providing tools, the Title V team also intends to increase training, educational opportunities, and technical support for local health departments, family planning providers, and staff on the relationship between patient outcomes and the annual preventive medical visit. This will be accomplished through monthly webinar meetings, implementation of the 2025 Needs Assessment (implementation will begin in 2024), and development of trainings based on the needs of local health departments and reproductive health clinics.

Increase training opportunities and technical support for partners and providers to expand access to preventive services, including paying sources, access to referral networks, and establishing permanent health care homes.

The Title V program continually collaborates with local health departments and reproductive health clinics to gain insight into client barriers to accessing care. With the waning of the COVID-19 pandemic, Reproductive Health Family Planning staff from the Title V team have been seeking feedback from reproductive health clinics. Reproductive Health Family Planning clinics report a lot of confusion in enrolling, billing, and overall use of Family Planning Only Services.

The Wisconsin Title V program will work to create more user-friendly tools that local health departments and reproductive health clinics can utilize to increase their knowledge base and understanding of Family Planning Only Services, including how it works and how to enroll clients. By creating easy step-by-step instructions, clinics will be able to assist clients in their communities with getting coverage for annual visits along with other services. Clinics will be able to decrease the financial barrier of getting clients their annual visits while educating clients on all services that may be covered at no to low cost. This will help increase rates of the annual well-visit while also working to establish a permanent medical home for clients.

Implement training and education on implicit bias and anti-racism in healthcare delivery. 

Although this work has had trouble in the past, the Reproductive Health Family Planning team is confident in meeting this goal for the 2024 grant year. A little over three-quarters of clinics are funded by the Title X federal grant program, which requires annual trainings on implicit bias and anti-racism in healthcare.

The training team has already implemented annual trainings with the program’s clinics and are incorporating these annual trainings into some of the Reproductive Health Family Planning network monthly meetings. All participating program clinics, including local public health departments and non-profit clinics, are required to attend these meetings. The Reproductive Health Family Planning team has created new ways to track subrecipients who attend the meetings.

The Title V program is also developing a plan for subrecipients keep track of their completed trainings and submit them to the Reproductive Health Family Planning team. This will allow for all subrecipients that have completed the required trainings to receive credit. This requirement will continue through the 2024 grant year and the trainings will be updated as new information on implicit bias and anti-racism become available.

Support continued improvement of equity issues in clinic-level data collection. 

Health equity efforts will be expanded during 2024 through the improvement of data quality collected from reproductive health family planning clinics. This work will be led by the Reproductive Health Family Planning Epidemiologist. To assess whether reproductive health clinics are meeting the needs of clients who may need culturally competent care, it is critical to start with complete data that includes race, ethnicity, income, and level of English proficiency. Much of this data is currently missing for clients served at Title X sites due to a transition in data collection systems in 2022.

A descriptive assessment of populations, including LGBTQIA+, adolescents, and persons with disabilities, in need of culturally competent services will be conducted in 2024. With a more complete picture of populations being served, gaps in services can be found and a plan to improve services can be made. This work will be measured by the percent of race and ethnicity data reported from clinics participating in the Title X Reproductive Health Family Planning program, aiming for more than 90% of clinical encounters capturing race and ethnicity information. These data will be collected using REDCap.

A major challenge in accomplishing this strategy in 2024 is a data system transition for the Title X program. The Office of Population Affairs that administers the Title X grant is changing the data requirements and submission process. The Reproductive Health Family Planning Epidemiologist is working with clinics to implement quarterly data quality checks with submitted data to address a drop in data completeness and quality due to this transition. This change does give the opportunity to address data quality issues first with the strategy to improve data completeness related health equity.

Maternal Mortality Review

In 2024 the Maternal Mortality Review program expects to convene its Maternal Mortality Review Team six times – every other month – to review cases. In addition to the normal case review process, the team plans to implement an expedited review process of its 2018-2019 cases, which were put on hold in order to meet funding requirements. This expedited review will allow the Maternal Mortality Review program to catch up on case review and subsequently release a larger, more comprehensive multi-year report. This team also hopes to continue to implement Black Mamas Matter Alliance recommendations around increased transparency and community involvement in maternal mortality review.

The Maternal Mortality Review program collaborates closely with the Title V program and expects that their Impact Team will continue to meet throughout 2024 to widely disseminate information and ensure implementation of Maternal Mortality Review Team recommendations across the state.