FRESNO – When United Health Centers of the San Joaquin Valley identified a gap in its patients’ access to contraceptive care, it set out to fill it — not just at one or two locations, but across its entire network of federally-qualified health centers in Fresno, Tulare, Kern and Kings County.
Just a few years ago, United Health Centers had no standardized method of screening patients for their pregnancy intentions or contraceptive care needs. Now, 67% of eligible patients who receive care at a United Health Center location are both screened and have access to a wide variety of contraceptive care options.
This is thanks to a partnership between UHC and nonprofit Upstream USA that began nearly three years ago. Within that timeframe, the work the two organizations have done together has been so successful that UHC, Upstream and other Valley-based healthcare providers celebrated it with an evening of reflections and a fireside chat at a special event Aug. 5.
“We have accomplished a lot in the last couple of years … with all the patients’ lives that we’ve been able to touch and expand this care to, so I’m really proud of that,” UHC President and CEO Justin Preas said.
Celebrating commitment
Upstream USA is a national nonprofit focused on improving access to contraceptive care, particularly through primary care providers. CEO and Co-founder Mark Edwards said Upstream began in 2014 with the premise that “high-quality, patient-centered contraceptive care should be part of just basic primary healthcare.”
“It’s not just for specialty family planning clinics, it’s not just for women’s health,” Edwards said. “It is really for basic primary healthcare.”
UHC quickly became a favorite partner of Upstream’s, Edwards said, because of the unwavering commitment UHC has to center its patients and what they need, “and to do everything possible to ensure access, particularly at this moment in time.”
“It is really the healthcare heroes in this building and all the other sites around the Central Valley that make this possible, and so we feel very grateful to have this kind of partnership and the idea of just making sure that anybody can get access to the contraceptive care they need so they can achieve their goals,” Edwards said.
Upstream President and Chief Operating Officer Jessica Foster added that most health centers and large systems they work with prefer to start small, piloting changes at a few sites and seeing how it goes.
“United Health Centers said, ‘We want to improve access for our patients as quickly as possible, and we are going system-wide out of the gate to all 40 sites in our network,’” Foster said.
Contraceptive care
Since the partnership with Upstream started, UHC has been able to increase its rate of screening patients for their pregnancy intentions, train more than 600 staff members across more than 40 sites, certify all of its sites for a state reimbursement program and credential its healthcare providers in long-acting reversible contraception.
During the event, Upstream USA Practice Transformation Lead Cate Clegg-Thorp led UHC Associate Medical Director Dr. Banujan Balachandran and Chief Administrative Officer Miguel Rodriguez in a fireside chat to reflect on what UHC has accomplished.
Balachandran, who has focused his career on providing full-spectrum primary care in medically underserved communities, said UHC approached filling its contraceptive care gap with a sense of urgency that came from everything providers see in their communities every day.
Balachandran said nearly 50% of all pregnancies in California are unintended, and that includes teenage pregnancies and short-interval pregnancies in the Central Valley. Unintended pregnancies, he said, are associated with poor maternal and fetal outcomes and they impact education, financial stability and the overall well-being of families both today and in future generations.
“We as healthcare leaders needed to be better, and we asked ourselves, ‘How are we going to do this?’” Balachandran said. “Partnering with an organization like Upstream gave us the opportunity to take good intentions and translate that into actionable plans, protocols, screening guidelines, operational workflows, so that we could extend access for our patients.”
Now, Balachandran said that across all UHC locations, providers are able to have patient-centered discussions where patients can make decisions aligned with their values and goals for the future.
At a primary care visit with a UHC provider, this looks like providers asking patients a screening question related to their intentions to become pregnant, Rodriguez told the Mid Valley Times.
If the patient wants to become pregnant, the screening leads the provider to discuss things like nutrition, prenatal vitamins and whatever else might be needed to help the patient accomplish their goal, Rodriguez said. If they don’t wish to become pregnant, the provider will be led through a discussion with the patient on access to contraceptive care and the patient’s preferred methods.
Although these things may have been talked about and included as a note in a patient’s chart prior to UHC’s partnership with Upstream, the process is now more streamlined and better documented, Rodriguez said.
Provider partnership
In an interview with the Mid Valley Times, Rodriguez said United Health Centers first became connected with Upstream USA through a roundtable discussion in early 2024.
Fresno-based physician Dr. Rais Vohra, who at the time was the interim health officer for the Fresno County Department of Public Health, invited UHC to join a discussion with Upstream, UCSF Fresno and the health department to talk about challenges to accessing contraceptive care in the Valley.
UHC then began to speak with Upstream more in-depth about what a partnership between the two organizations would look like, Rodriguez said.
When UHC began to look at the access its patients had to contraceptive care, it found that there was additional training its providers needed to feel comfortable with discussing all the different types of contraceptive care methods that are available, Rodriguez said.
UHC also identified that it had a significant gap in the reimbursements it received when providing contraceptive care to patients. For some implant devices, for example, UHC found that it was losing roughly $1,000 per visit to offer them to patients due to the rising cost of the device and the reimbursement model, Rodriguez said.
Rodriguez said the goal in working with Upstream was to then go beyond just ensuring UHC was training its staff and providing access to contraceptive care. It was to make it so UHC could provide a patient’s preferred method of contraceptive care no matter what that was.
To achieve this, Upstream helped UHC re-certify its sites for the California Family Planning, Access, Care and Treatment (PACT) Program, which helped UHC recover costs. Rodriguez said Upstream’s advocacy arm also helped UHC work at the state level to bring attention to red tape that was making it difficult to get sites certified.
Rodriguez said this allowed UHC to get all of its sites recertified.
“That really eliminated a huge barrier that we had … and made a huge difference in our ability to provide access to services at all of our locations,” Rodriguez said.
Rodriguez said that moving forward, UHC hopes to continuously improve the number of patients it’s screening for contraceptive care and keep up with training new providers. He said UHC is thankful to Upstream and the county health department for making the introduction.
“Our goal is to provide accessible healthcare to all the patients that we serve, and … we’ll be able to continue to build upon what we’ve done here into the future,” Rodriguez said.
