Katie Thiede and Kai Tao of ICAN! talk increasing access to reproductive health services
Launched in 2021, the Illinois Contraceptive Access Now, or ICAN!, is a startup that aims to increase access to reproductive health services in the state.
The five-year initiative recently announced the addition of Friend Health Center and Howard Brown Health in Chicago, SIU Center for Family Medicine in Springfield and SIHF Healthcare in southern Illinois to the ICAN! network. Existing partners include Chicagoland’s Erie Family Health Centers, Near North Health and PCC Community Wellness.
“With the addition of our four new health center partners, those community health centers together reach a combined 50,000 women of reproductive age,” ICAN! co-founder and Executive Director Katie Thiede told Health News Illinois this week. “And so with this expansion of our reach, we’re able to essentially touch almost a quarter of all of the patients of reproductive age who are accessing their care at community health centers.”
Thiede, as well as Kai Tao, ICAN! co-founder and principal of impact and innovation, also spoke on the goal to work with 20 of the largest federally qualified health centers and community health centers across the state by 2025, creating a new standard of care where screening for contraceptive needs and desires are common, and its role in the face of a growing national push to restrict access to reproductive health services.
Edited excerpts are below.
HNI: Can you tell me more about the work of ICAN!?
Katie Thiede: ICAN! is a five-year statewide initiative with a mission to advance reproductive health equity in Illinois by improving both the quality and coverage of contraceptive care. The vision for ICAN! is to ensure that every person in Illinois has the ability to decide if, when and under what circumstances to be pregnant and a parent. The organization really is aiming to accomplish three goals. We work to improve the delivery of patient-centered contraceptive counseling at community health centers. So we primarily work with federally qualified health centers … We also have a goal of decreasing the number of people who are without health coverage for contraceptive care … And then, in addition, we’re working to expand points of access to contraceptive care and education and really looking beyond the walls of the health center.
HNI: The initiative recently announced four more organizations are joining the network. How will that further help with access?
Thiede: With the addition of our four new health center partners, those community health centers together reach a combined 50,000 women of reproductive age. And so if you think about the landscape here in Illinois, there are about 2.5 million women of reproductive age, about 400,000 of those women are accessing their care at community health centers today. And so with this expansion of our reach, we’re able to essentially touch almost a quarter of all of the patients of reproductive age who are accessing their care at community health centers. And we know that our community health center partners are oftentimes reaching folks who have the fewest access to resources and typically have the least access to high-quality contraceptive care. So our work with health centers is really to improve the number of individuals who are accessing high-quality contraceptive care, but more importantly to really address the profound disparities that exist in the state by strategically partnering with FQHCs.
HNI: Can you explain more how these collaborations increase access to contraceptive care?
Kai Tao: These federally qualified health centers, they’re all doing within their means, within their current infrastructure as best they can, for the most part, to deliver what we call medically accurate, age-appropriate quality sexual healthcare. However, there is a lot of room for improvement, and so what we’re doing is really helping them create the situation within their health center or within their microenvironment to be able to say, ‘Hey, let’s make sure we can offer all options for same day.’ What we mean by same day is if that patient comes in, and she or he or they are requesting a certain method of birth control, we’re not going to delay it. The only reason we do delay if there was truly a clinical contraindication or the patient said, ‘I’m not ready.’ But otherwise, there should be no delays that are based on, ‘We weren’t sure how to get the supply,’ or ‘It’s going to take a few weeks to look into how … we can afford it.’ All these things are logistical, and so a lot of work that ICAN! does is really trying to increase the technical capacity of these health centers so they are doing a better job of being able to procure all (Food and Drug Administration)-approved methods for same-day delivery. And because it’s an FQHC, the premise is really it’s either no cost or low cost, and you will never be turned away for inability to pay.
HNI: What are the next steps for ICAN!?
Thiede: One of the things that we did in 2020, before launching ICAN! was to take a look at the national landscape analysis, what was happening with other contraceptive access projects that we could learn from. We did a statewide listening tour where we connected with over 70 stakeholders across the state, and we talked to about 600 individuals who might be either birth-control users or considered of reproductive age, folks in our priority population, to really understand what their needs were and what the landscape was here in Illinois. When we did that, we also looked at a tremendous amount of available public health data and identified communities across the state where disparities related to access to reproductive health and where reproductive health outcomes were the greatest. And so those communities are the ones that we really prioritize when we think about identifying potential partners to become quality hubs with ICAN! But, in addition to that, we’re looking at federally qualified health centers that have a fairly significant number of patients, we typically think of the threshold being about 20,000 patients that they see annually, because we want to make sure that they also have the infrastructure that is necessary to be able to implement an initiative like this. That’s not a hard and fast rule, but that’s generally what we’re looking for.
And then, most importantly, looking to identify partners who are really committed to this work who recognize that it is going to require some significant cultural and operational change to de-silo and destigmatize sexual and reproductive healthcare from the primary care setting. That’s a pretty significant change for many, many reasons. But, for far too long contraceptive care has been seen as either a women’s health issue or something that isn’t really a part of routine primary and preventive care.
Tao: We often talk about de-silo and destigmatizing, but really it’s so it becomes more natural. I think every one of us has been to a healthcare provider, and one of the basic tenets we talk about is, ‘Do you smoke, drink, do drugs?’ And then more recently in the last two decades, where we’ve really seen de-silo and destigmatizing around mental health and behavioral health issues, ‘Have you felt sad or lost interest in any activities the last two weeks?’ That’s pretty routine, whether you’re going in for your annual exam, or a broken ankle. And that’s the idea we’re trying to do with embedding this question, similar to, ‘Do you think you want children at some point? Or do you want children or be pregnant next year?’ There are variations in a way we’re not being prescriptive, but however it’s asked, it’s obviously in a very patient-centered way and shared decision making is at the heart of it.
HNI: What are some of the challenges you’re facing when expanding into rural communities or urban areas with less access to healthcare?
Tao: I don’t think anyone’s had a conversation without bringing up COVID. So with what’s happening in healthcare, one of the challenges we are facing is people recognize and our FQHCs recognize this as important, but they need the human resources and the workforce to do this. And so I think that’s one of the challenges that’s not going to just go away, even as hopefully our pandemic weans down. And so it’s getting staff trained and feeling confident and feeling they are empowered to talk to people about this, because it has not been historically, like we said, it’s either women’s health, so you’re a women’s health provider, or you might even think of it as specialty care. People go, ‘Oh, go to a family planning specialist’ versus whether your primary care doctor should be able to just start you on whatever method that you want, without thinking it’s specialty care. So it’s getting providers and their support staff to feel comfortable, to educate, counsel and talk about all methods. It’s totally doable, but we have to be very cognizant of our challenges.
Thiede: One area that we don’t always think about when we think about care at community health centers is the really critical role that they play as well in helping people to access coverage for healthcare and to help folks identify coverage that they may be eligible for, support enrollment activities, financial counseling for patients who are looking to access care. So that aspect of the workforce has also been really impacted by COVID. And so when we partner with our community health centers, we’re really looking to think about how can we build efficiencies within their model to make sure that folks who do have eligibility to access benefits for coverage are able to get it so that, honestly, the health center can reserve the precious few resources that they have to care for the truly uninsured, for those folks who don’t have additional benefits, so that we can ensure that the financial performance of our health centers remains really strong.
HNI: What impact have national conversations on access to reproductive health services had on your work?
Thiede: We have very unfortunately seen many states, including Texas, Oklahoma, Kentucky and Tennessee enact these really egregious, racist policies and policing people’s bodies. And we’re fortunate that here in Illinois, we have very strong community and government leadership that has not only been a leader in advancing progressive reproductive health policies, but continues to do so in recognition of just how important it is to ensure that all people have the ability to decide if, when and under what circumstances to be pregnant or a parent and to have autonomy. In 2019, Illinois enacted the Reproductive Health Act, which in part codifies the protections of Roe v. Wade here in Illinois and ensures that there is treatment of contraceptive care, abortion care, maternal healthcare, like all other medical care, which is essential. I would say there’s also this incredible need for us to keep going, to translate those policies into action and to make sure that Illinois truly is a leader in not only advancing progressive policies, but in really democratizing access to that healthcare as well. And I really applaud the state and stakeholders across the state for recognizing that there’s more work to do and for leading on the policies that we’ve already led on.
We have heard from our colleagues in this space who are really preparing for not only an increase in service demand but also looking to say, ‘How can we reach across state lines to partner with stakeholders in other states?’, knowing that there may be increasing demand for people to travel to Illinois to access certain aspects of healthcare. And really, how can we as a community not only support increased demand but continue to really ensure that the people of Illinois have the greatest access? We can truly be a model for what other states can look to.
HNI: What more can policymakers do to support this work?
Thiede: We are looking to advance a model family planning state plan amendment, and really make sure that we think about not only having the most generous coverage possible, but also thinking about how do we support enrollment. How do we make sure that the people who really need to access the benefits of these policies know about it, that it’s a seamless process, that there aren’t these many different steps and applications that people have to go through to try to understand how they can get certain aspects of coverage that they qualify for? So really thinking about how we implement that policy very well with the end user in mind. And what can we do to encourage different state agencies to support the outreach and education efforts related to that? We’re also looking at how can we work with our managed care organizations. Here in Illinois, about 85 percent of Medicaid beneficiaries or members are enrolled in an MCO plan. And so we want to work with those managed care organizations to think about how can we make sure that their network coverage is adequate. Yes, they might have an OB-GYN in their network, but does that OB-GYN provide full scope, contraceptive care? Are there enough people in the network with close proximity to their members to be able to actually provide adequate coverage? We want to make sure that the MCOs are engaging with us around improving the transparency with their members. An individual can go anywhere to access contraceptive care. Iit doesn’t have to be in-network. We have the Federal Freedom of Choice Act. So for folks who are on Medicaid and enrolled in an MCO, they don’t have to stay within their network. And we want to make sure that we’re really working with the MCOs to promote this so that folks know they have choices and they have options.
Tao: We are also really an interesting state where we have one in three healthcare systems that are religiously affiliated. So what that means is they may practice the ethical and religious directives, often under Catholic doctrine, but it could be others, where they are not able to offer birth control for pregnancy prevention. So that means a lot of people who live in places where there might be just one healthcare system that is religiously affiliated actually cannot get easy access to birth control. And so, we want our managed care organizations to find ways to help that client if they are truly covering them and getting paid for them.