Facilitators and Barriers to Implementation of Immediate Postpartum LARC Programs within Pennsylvania Hospitals 7 Years after PA Medicaid Reimbursement.

Objective: To evaluate facilitators and barriers to implementation of immediate postpartum LARC (IPLARC) within Pennsylvania (PA) hospitals seven years after PA Medicaid adopted coverage of IPLARC outside the pregnancy care bundled payment, with particular attention to rural, small, or non-academic hospitals.

Study design: We conducted ten qualitative interviews representing ten unique hospitals from an opt-in subset of participants in our quantitative survey of clinician leaders at PA Labor and Delivery units. Transcripts were analyzed using grounded theory methodology. We coded and analyzed transcripts using MAXQDA software.

Results: Several themes emerged from the data; three of which are novel. Firstly, that passage of Medicaid reimbursement was necessary but not sufficient for widespread implementation of IPLARC. We also found that hospital mergers and consolidations facilitated the capacity of smaller hospitals to implement and sustain IPLARC and that the Pennsylvania Perinatal Quality Collaborative was a utilized resource.

Conclusion: Medicaid coverage of IPLARC is a necessary facilitator but not sufficient for all hospitals to implement this service. Smaller, non-urban hospitals may benefit more from network-level support and state Perinatal Quality Collaboratives than their larger, academic urban hospital counterparts.

Implications: Medicaid coverage of IPLARC was a necessary facilitator but not sufficient for all PA hospitals to implement this care. Internal support from larger hospital systems via buyouts/mergers and external support programs (state Perinatal Quality Collaboratives) may play a larger role in implementation at smaller, rural, or non-academic hospitals.