Efforts now underway to reform how medical care in the United States is provided and paid for must fully incorporate reproductive health, argues a new analysis in the Guttmacher Policy Review. Spurred by the Affordable Care Act (ACA), the U.S. health care system is transforming rapidly as various actors experiment with new ways of delivering, coordinating and paying for patient care under private insurance, Medicaid and Medicare. The goal of these efforts is to achieve better care and better outcomes at lower costs.

"It is critical that reproductive health care and providers are fully integrated in this process, both in their own right and in the interest of broader health goals," says Adam Sonfield, author of the new analysis. "But this inclusion should not be taken for granted. Efforts to overhaul health care delivery and payments have largely focused on high-cost and high-risk patients, conditions and providers, and are often driven by Medicare, which primarily serves an older population. Reproductive health is not usually a focus area for these efforts."

A new set of principles drafted by national provider and advocacy groups in the field of reproductive health and rights, including the Guttmacher Institute, lays out priorities for integrating reproductive health into broader reform efforts. These principles are intended as a guide for policymakers, health plans and other decision makers and fall into five core areas:

• Access to care: Reform models should ensure patients’ access to comprehensive, high-quality, well-coordinated reproductive health services. This encompasses access to the full range of reproductive health services, including contraception, abortion, STI screening and treatment, and maternity care.
• Access to providers: Patients must have full access to a comprehensive choice of reproductive health providers, within or outside a health plan’s provider network. This must include safety-net family planning centers, specialized abortion providers and other providers offering reproductive health care.
• Patient safeguards: Reform initiatives should include patient protections, in particular those important to reproductive health care, such as confidentiality, a commitment to patient autonomy, and access to all covered services and information, free of ideological or religious interference.
• Payments and investments: Reproductive health providers should be reimbursed in full for their services and reimbursement should account for the value of preventing unintended pregnancies, STIs and reproductive cancers. Financial incentives must not undermine patient care and safeguards.
• Patient and provider engagement: Representatives of the reproductive health patient and provider communities need to be included in developing, governing, implementing and evaluating reform initiatives. They should also be provided the financial resources, when needed, to be able to participate fully in these efforts.

"Even with the future of the ACA now in question under a Trump administration, these broad delivery system and payment reform efforts will continue to have significant momentum," says Sonfield. "Certainly, U.S. women and men will continue to rely on public and private insurance to obtain the reproductive health care they need. That is why ensuring that broader reform efforts are in line with these principles is not only in patients’ interest, but will ultimately help the overall endeavor succeed."