Instant Birth Control

Country: United States

Organization: Planned Parenthood of the Columbia/Willamette

Focus of activity - Service/process

Year the initiative began (yyyy) - 2004

Main barrier addressed: Health care not consumer friendly
Main insight addressed: Simplify through technology

Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? In April 2004, Planned Parenthood of the Columbia/Willamette (PPCW) became the first family planning provider in the US to offer qualifying Oregon women access to hormonal contraception (e.g., birth control pill) online. In May 2006, PPCW began providing contraception online to women in Washington State, through a common web infrastructure housed in Portland. In October 2006, PPCW launched Instant Birth Control, a multi-media campaign which significantly increased web traffic, patient visits, and online contraception sales. Since April 2004, 2,363 Oregon and Washington women have accessed Instant Birth Control.

For more than 14 years, standards of medical practice have uncoupled the requirement of a pelvic exam to receive hormonal contraception. Hormonal contraception can safely be provided based on careful review of medical history and blood pressure measurement. (Journal of the American Medical Association, May 2001)

Instant Birth Control patients receive all necessary health screening and monitoring to ensure safe, quality care. Patients may have the prescription called in to a pharmacy, pick up medication at a PPCW health center or have medication mailed to them.

Increased access to reliable birth control methods is key to reducing unintended pregnancy and abortion rates. Instant Birth Control increases access to reliable birth control by:
* Providing 24/7/365 access, accommodating busy work or family schedules
* Eliminating geographic barriers, serving women regardless of physical distance from a provider or pharmacy
* Honoring women’s desire to keep personal choices private from doctors or pharmacists who may not respect the decision to use contraception
* Serving women whose anxiety about the pelvic exam prevents them from starting or continuing reliable contraception
* Easing women into an ongoing relationship with a provider by starting online first
* Reducing cost of care through economies of scale, allowing providers to serve more women

Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. The provision of many health care functions is gradually moving from complex to simpler environments, reducing cost of care and barriers to access. For example, surgeries than can be performed on an outpatient basis are now available in an ambulatory surgical setting vs. hospital operating room. We can obtain blood pressure readings at the grocery store. National pharmacy chains employ nurses to administer vaccines and advise customers.

What environment is simpler for accessing health care, presenting the least number of barriers, than a person’s own home? More and more health care providers now offer patients or members online tools to message their providers, request appointments or prescription refills. Most online tools facilitate communication between patient and provider, or present tools to manage conditions already diagnosed and treated. The next logical step was providing an online tool for patients to access primary care – including screening, diagnosis, and treatment.

Uncoupling the requirement of a pelvic exam to receive hormonal contraception was a critical simplification that removed access barriers for many women, especially younger women. Instant Birth Control gives women access to primary care 24/7, in the privacy of their own home, convenient to their own schedule, supported by nurses or nurse practitioners. Instant Birth Control transfers the power to the patient. No more long waits in busy offices, missing school or work, traveling great distances or facing the judgment of providers or pharmacists, to exercise a basic choice regarding reproductive health.

Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? Instant Birth Control is available to any woman in Oregon and Washington with a credit card and access to the internet. First, a woman completes an online patient intake form similar to what she would complete at a health center. Next, she reads about and selects a method of hormonal contraception (e.g., birth control pill). A registered nurse or nurse practitioner reviews her health history and follows up by phone if necessary. Once the patient is approved, we send her two months of medication in the mail, call in a prescription to her pharmacy, or have her medication ready at a Planned Parenthood health center for her to pick up. The patient submits a two-month blood pressure reading from a qualified health practitioner. If her blood pressure is within appropriate limits, she may request up to eleven more cycles of medication.

In 2006 PPCW partnered with the international ad agency Weiden + Kennedy, whose clients include Nike, Starbucks, Visa and Honda. Weiden + Kennedy donated their services to design the “Instant Birth Control” campaign. The humorous premise behind Instant Birth Control is that some male behaviors are so repellent to women that they cause “instant birth control.” The campaign tagline is: “(almost) Instant Birth Control: online birth control from Planned Parenthood. No stirrups. No clinic. No hassle. www.instantbirthcontrol.com.”

The Instant Birth Control campaign ran in the fall/winter of 2006. The campaign targeted urban, computer-savvy women 20-29 years old and consisted of print, radio and web-based advertising, postcards and posters. Over 17,000 people visited www.instantbirthcontrol.com in ten weeks; nearly 7,000 visitors clicked through to PPCW’s web site. Web site visits increased 34 percent, and sales of Instant Birth Control increased 20 percent.

Our current market penetration is 0.8 percent of Oregon and Washington women ages 13-44 who use the birth control pill or Ortho Evra Patch as their chosen method of contraception.

Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. PPCW worked closely with the Oregon and Washington Boards of Nursing and Pharmacy to identify and resolve barriers to providing Instant Birth Control. For example, to prescribe and provide medication to women living in Washington from our Oregon office, we negotiated agreements with the Board of Pharmacy in Washington. Getting approval from these four boards to provide online services was an arduous process. In the end, each partner came to agreement, in order to increase access to contraception for women in both states.

PPCW collaborated with the four other Washington Planned Parenthood affiliates (Planned Parenthood of Western Washington, Central Washington, Mt. Baker and the Inland Northwest) to bring Instant Birth Control to Washington women through a common web infrastructure in Portland. Together we created a collaborative business model in which the five affiliates share operating expenses and revenue. This model is in the process of being replicated by other affiliates around the nation for other services.

PPCW partnered with the international ad agency Weiden + Kennedy, which donated services to design and create collateral materials to market Instant Birth Control. Our collaboration with this high-profile agency resulted in the most sophisticated, edgy and fun marketing campaign PPCW has ever produced, and one that greatly appealed to our target audience.

Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? Instant Birth Control sits within PPCW’s Online Health Center, which also provides emergency contraception online and nurse advice online. The operating budget for the Online Health Center in FY 2008 is:

$228,780 Revenue (Fees from patients)
$160,976 Expenses (70% personnel expenses; 10% contraceptive supplies)
= $67,804 Surplus

Instant Birth Control visits (initial visits, re-supply orders and blood pressure checks) represented 81 percent of Online Health Center visits in FY 2007. If we prorate revenue and expenses based on 81 percent for Instant Birth Control, the operating budget for Instant Birth Control for FY 2008 is:

$185,312 Revenue
$130,391 Expenses
= $54,921 Surplus

PPCW’s Online Health Center was established to be self-sustaining. In December 2006, after twenty months of operation, the Online Health Center achieved this goal.

Surplus revenue from Instant Birth Control and the Online Health Center go to PPCW’s Unrestricted Operating Fund, which helps PPCW provide other reproductive and sexual health care services to low-income and uninsured women, men and teens.

Not covered by the Online Health Center’s operating budget are major capital expenditures (e.g., new software), marketing initiatives and professional services necessary to expand Instant Birth Control beyond its current market.

What is your annual operating budget? 16,291,169
What are your current sources of revenue? (please list any sources that are foundation grants) PPCW’s fiscal year runs July 1-June 30th. Projected operating revenue for FY 2008 is $16,291,435. Operating revenue sources are:
* Patient Fees $13,802,575 (fees for health care services, from public or private insurance programs or patients)
* Government Grants and Contracts $475,650 (Title X and Washington State Department of Health grants for family planning services to low-income women)
* Private Contributions $1,986,960 (Individuals, foundations and business contributions)
* Miscellaneous Revenue $26,250 (Merchandise sales, investment income)

Historically, foundation support has played a greater role in capital projects at PPCW than operating support. Foundation operating support increased from $55,775 in FY 2004 to $149,677 in FY 2007. Foundation operating support is projected to total $200,000 in FY 2008. As of July 18th, the one grant secured is $24,500 from United Way of the Columbia/Willamette.

Over the last several years, PPCW has more than doubled the number of women, men and teens we provide with quality, affordable reproductive and sexual health care. In order to double again the number of patients served, providing increased access for all, PPCW is undertaking a $12.5 million capital campaign to build a new Regional Service Center in Northeast Portland and renovate our crowded Southeast Portland health center. We anticipate raising approximately $3.5 million from foundations for this capital effort.

The first floor of the 45,000 sq. ft. Regional Services Center will house a state-of-the-art N/NE Health Center, the expanded Online Health Center including Instant Birth Control, an accredited ambulatory surgery center, a centralized warehouse, and retail available to merchants. The second floor will be occupied by our Education and Public Affairs Departments. The third floor will house the administrative staffs who provide system-wide finance, marketing, development, and management support.

Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? Since April 2004, 2,363 Oregon and Washington women have accessed Instant Birth Control.

Instant Birth Control is a pilot for Planned Parenthood Federation of America (PPFA), the leading family planning provider in the United States. PPFA's 116 independent affiliates provide what is essentially a specialized national system of care, in which patients move between health centers, across the city or across the nation. One in four women in the United States accesses care from Planned Parenthood at some point during their lifetime.

Instant Birth Control represents an entirely new model of service delivery, which can be replicated by any Planned Parenthood affiliate or family planning provider in the nation. PPFA has now committed to establishing one single online health center for all affiliates, with the potential to serve more than five million women, men and teens per year. This commitment has already begun to affect the governance of each affiliate and our national federation, as each affiliate moves toward some degree of coordinated online health services.

PPCW’s partnership with four Washington affiliates also represents a revolutionary collaboration crossing geographic boundaries, providing health care services through a common infrastructure housed at one affiliate. Five affiliates share operating expenses and revenue. This model is being replicated by other affiliates around the nation, to reduce duplication of health care or support services where appropriate and take advantage of economies of scale.

Instant Birth Control was the impetus behind changing regulations in Oregon and Washington that stood in the way of online health care delivery. As we look to other states to expand our range of practice, each state will require a similar examination and changes to enable online services. This process will not only benefit women seeking convenient access to contraception; it will benefit other providers who wish to offer health care online.

Which element of the program proved itself most effective? The most effective element of Instant Birth Control has been our ability to break down barriers many women face to conveniently accessing reliable birth control. Instant Birth Control gives any Oregon or Washington woman with internet access and a credit card the ability to obtain contraceptives from the privacy of her home, or even her local library. Our patients love it.

“A young woman placed an online order for contraceptives. When I called to review her medical history, she told me she is a single parent and the mother of four children under five years old. She also works and takes classes at night. She has absolutely no time. She was so grateful that we offer this service.” ~ Vickie, Online Health Center

“A single mother of two young children just moved to central Oregon. She is not due for her annual, nor can she travel to a health center until she finds some new child care arrangements. This service was convenient and helpful.” ~ Virginia, Online Health Center

“This innovative program of providing birth control through an online process holds much promise for providing safe, effective birth control to women in need. This is especially important for women living far from a center where they can get physical help, and for all of those busy individuals who have difficulty making time to come in for an exam and would rather take responsibility for their sexual health on their own time, from the convenience of their own home.” ~ Fletcher, B., et al. Instant Birth Control: Who is buying the Pill online? Unpublished manuscript, Stanford University, Graduate School of Business. Palo Alto, CA.
Number of clients in the last year? 1,142 women in Oregon and Washington accessed Instant Birth Control from PPCW from July 2006-June 2007.
Since April 2004, three in four Instant Birth Control patients have been between the ages of 20-29 years old. Sixty-four percent of patients were new to PPCW; the rest were established patients.
What is the potential demand? The Guttmacher Institute defines “women needing contraceptive services and supplies” as women during a given year who are aged 13–44; sexually experienced; able to become pregnant; and, during at least part of the year, neither intentionally pregnant nor trying to become pregnant. In 2002 there were over 1.1 million women in Oregon and Washington needing contraceptive services and supplies. http://www.guttmacher.org/pubs/state_data/methodology.pdf
If national averages hold true for Oregon and Washington, approximately 89 percent of these 1.1 million women are actively practicing contraception; approximately 27 percent have chosen the birth control pill or Ortho Evra Patch. http://www.guttmacher.org/pubs/fb_contr_use.html#2

Therefore, the potential demand for Instant Birth Control currently consists of over 297,000 women in Oregon and Washington. Certainly not every woman would choose to access services online, and most women discuss and receive contraception during an annual exam in a provider’s office. However, Instant Birth Control could play an important role in streamlining contraception access for women whose schedules, distance from a provider or pharmacy, or desire to keep their personal choices private preclude visiting a provider’s office every time or any time.

Nationally, there are nearly 12 million women in the United States actively using the birth control pill or Ortho Evra Patch. As Instant Birth Control spreads into other states, the untapped potential for helping women access convenient, reliable contraception can rise into the millions.

Scaling up Strategy - What is your priority for the next 3 years and please describe why. We have four priorities for expansion.

We will improve the customer experience online when purchasing Instant Birth Control. The current online interface replicates what the patient’s experience would be in a doctor’s office: identify a method of payment, fill out medical history forms, consult with the provider and get your prescription. We found out that patients wanted more of a standard online shopping experience: choose your product, place it in the shopping basket and check out. Patients were often discouraged by the many steps necessary to see the product they might buy. We are redesigning the interface to address the wishes of our patients, while still collecting the medical information necessary to provide quality care.

We will integrate the new online patient interface with the electronic practice management (EPM) (medical billing) and electronic health records (EHR) systems we are implementing over the next twelve months. In another inter-affiliate partnership, PPCW and three other affiliates across the country are modeling how all Planned Parenthood affiliates could be electronically connected, better serving our mobile patient base and improving practice efficiency. PPCW anticipates going live with the integrated EPM and EHR system in Spring 2008.

We will launch a second and expanded run of the Instant Birth Control campaign in partnership with Weiden + Kennedy. This partnership will include additional tools such as podcasts, viral marketing through community sites, and blogging by patients and providers.

We will recruit affiliates in other states to participate in Instant Birth Control. This involves not only entering into business agreements with Planned Parenthood affiliates, but working with each state’s Boards of Nursing and Pharmacy to overcome any regulatory barriers. Expanding to other affiliates and states relies heavily on legal and public policy assistance. We are currently in discussion with affiliates in Idaho and Alaska.

Stage of the initiative: Scaling up
Expansion plan: Please see the above expansion priorities.

Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. While 79 percent of Oregon’s population lives in urban or suburban areas, 21 percent live in rural communities, separated by hundreds of miles, often barricaded by coastal or inland mountainous passes which are difficult to traverse in all but our few warmest, driest months. Compared to Oregon’s cities, our rural areas are predominantly conservative.

One day when driving back from our Central Oregon health center (four hours from Portland across the Cascade range), PPCW’s President and CEO watched ranches and small conservative towns pass by his window. Women living in these houses need private, compassionate access to contraceptive services just like women in urban areas. He thought, if these women have access to the internet, why can’t they have access to safe, effective and private contraception? When he came to work the next day, the concept for Instant Birth Control was born.

What are your two main challenges to finance the growth of your initiative - What are the two (2) main challenges in financing the growth of your initiative with respect to operating costs and capital expenses? What amount of financing would your organization need in order to scale up operations? The first challenge is securing the capital necessary to upgrade the online patient interface. We estimate requiring $300,000-$500,000 to upgrade the patient interface and fully integrate the interface with our new electronic practice management and electronic health records systems.

The second challenge is conducting the legal and public affairs work necessary to bill Instant Birth Control visits to public family planning programs, and expand Instant Birth Control to serve women in other states.

Currently about 60 percent of PPCW patients’ care is covered all or in part by state and federal partnership programs that help low-income women access annual exams and contraception. However, these programs do not reimburse PPCW for care provided online, making it harder for low-income women to access Instant Birth Control. In order to expand Instant Birth Control to other states, we must explore each state’s laws and regulations to identify barriers to providing contraception online.

We require approximately $500,000 for the legal and public affairs work necessary to expand coverage of Instant Birth Control by public family planning programs, and expand to serve other states.

How did you hear about this contest and what is your main incentive to participate? - (This answer will not be published on the website.) We heard about this competition through the Robert Wood Johnson Foundation’s web site. Instant Birth Control is a compelling example of an innovation that disrupts the established approach to providing basic health care. RWJF would bring expertise and capital to significantly expand this program.

Do you have an annual financial statement? - Yes.

Do you currently have an annual financial statement that tracks profit/loss? - Yes.

Contact Information:

Audrey Milner
Grants Manager
Planned Parenthood of the Columbia/Willamette
(NGO)

Submitted by: audreym

Discussions about this entry

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One less hurdle!

by ginsgan on August 20, 2007 - 14:05

You'll have my vote. The fact that birth control exists is not enough. Women need easy access to the prescriptions and methods of birth control that are right for them. Too many women don't have this. If you live in a rural area, it could be hours to the nearest clinic. If you are stretched thin working for minimum wage and raising children, even if you live five minutes from a clinic, you may never see the building during open hours. I would love to see this program expanded across the states!

Sensible planned pregnancies

by Anonymous on August 17, 2007 - 20:28

I applaud the efforts to provide intelligent services to those who are unable to understand or take necessary steps to create healthy, planned families.

Thank you for asking the tough questions!

by audreym on August 17, 2007 - 13:05

Expansion into Other States

Instant Birth Control already has a track record of successful expansion. The service launched in Oregon in 2004, after over a year of negotiation with Oregon’s Boards of Pharmacy and Nursing. PPCW immediately began negotiations with Washington State regulatory bodies and Planned Parenthood affiliates. In May 2006, PPCW began providing contraception online to women in Washington State, through a shared inter-affiliate revenue and expense model and common web infrastructure housed in Portland. We are confident that, with more time and resources, we can expand Instant Birth Control to serve millions more women.

Making Instant Birth Control available to women in states beyond Oregon and Washington will require partnerships with Planned Parenthood Federation of America, independent Planned Parenthood affiliates, and public policy decision makers in each state.

Planned Parenthood Federation of America (PPFA) is committed to making Instant Birth Control available to women all over the nation through a common, national online health center. Many affiliates have expressed an interest in making Instant Birth Control available to women in their areas. We are exploring business models for federation-wide partnerships. PPFA has also pledged financial support for updating Instant Birth Control’s current user interface, to more closely replicate an online shopping experience.

PPCW is already in conversation with several other states with favorable regulatory environments for Instant Birth Control. We need to conduct a national analysis of regulatory and legislative environments affecting expansion. This analysis will identify state-by-state requirements of the Boards of Nursing and Pharmacies.

Currently the only reimbursement option for Instant Birth Control is self-pay, creating a barrier for teens and low-income women. This state-by-state analysis will identify opportunities to include online health care as a covered service by state and federal family planning programs for teens and low-income women.

The result of this analysis will be a 50-state plan for Instant Birth Control Expansion. We require approximately $500,000 for the legal and public affairs work necessary to expand coverage of Instant Birth Control by public family planning programs, and expand Instant Birth Control to serve women in other states.

Annual Gynecological Exams

Instant Birth Control maintains a balance between emphasizing the importance of an annual gynecological exam, and removing barriers to reliable birth control based on anxiety about the exam. Opening up access to contraceptives via the internet has the potential to encourage women to seek and use other Planned Parenthood health services, because they receive compassionate, quality counseling and education online.

We have many outreach opportunities for encouraging Instant Birth Control clients to obtain an annual exam. Some Instant Birth Control clients get annual exams have other regular providers, but choose to get their birth control online due to its convenience, or fear of judgment from other medical providers. Some teens and low-income women purchase birth control online, choose to pick up their medication at a health center, and learn that next time they will be eligible for free services and supplies with an in-person visit and annual exam. Currently, about 25 percent of women who come to us for Instant Birth Control later schedule an annual exam with Planned Parenthood.

Regulatory Restrictions?

by tahn on August 15, 2007 - 12:59

Dear Ms. Milner:

This program appears to set Planned Parenthood onto its next incarnation and into the next generation. If indeed women are able to be prescribed online, this could lead to the potential of the ability to prescribe other medicines. This platform could indeed be truly disruptive. The main concern is that what are the true potentials of this project scaling up and expanding into other states? We can imagine the regulatory framework as it stand, so contentious over the issue of birth control, it can greatly limit the growth of this initiative. Certainly women across the U.S. can appreciate this, what is PP's work in the policy realm to help expand such access nationwide? Also, is there a component to this program to ensure that women are also receiving the annual gynecological exam?

Thank you in advance for your response!

Changemakers Team

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