School of Public Health

How Alaska Plans to Improve Quality of Care

March 2016

Women's, Children's, and Family Health | Division of Public Health

Kelly Keeter

For most women in their reproductive years, family planning and related reproductive health (RH) needs are the driving force for entry into the health care system; this relationship with their family planning provider is essential to addressing other preventive and primary health needs.1

Respondents to Alaska’s Five Year Needs Assessment identified access to RH services and behavioral health screenings as top priorities. Although Alaska has maintained longstanding family planning efforts in parts of the state, funding historically has been limited, as has been the geographic reach across the state, leaving critical gaps in access to these services in the majority of communities.

In April 2014, the CDC and US Office of Population Affairs released the evidence-based, comprehensive clinical practice guidelines, “Providing Quality Family Planning Services (QFP).”2 This document provides guidance for all aspects of care for individuals in their reproductive years. Alaska’s new goal is to increase the number of health care providers offering RH services who adhere to the national QFP guidelines.

The planned objective is: By 2020, increase by 5% over baseline the number of health care providers offering RH services who adhere to the QFP guidelines. To achieve this objective, program staff will utilize the following strategies:

  1. Define baseline, i.e., number of health care providers currently offering RH services who strictly adhere to QFP, in both private and public health care sectors, beginning with publicly-funded health care agencies.
  2. Once baseline is defined, program staff coordinates professional education opportunities that target specific provider groups that offer RH services, to increase their knowledge and adoption of best practices described in the QFP.
  3. After targeted professional education efforts, program staff will survey providers to assess adherence to QFP.
  4. Program staff will offer technical assistance to those providers who continue to fall short of the national standard in provision of RH services.

Through federal mandates or programmatic priorities, publicly-funded health care providers (e.g., Community Health Centers - “CHCs” – and family planning centers) are required to act as, or directly link with, primary care medical homes to assure provision of preventive and primary care services. Nationally, more than 6 in 10 women who obtained care at a publicly-funded center that provides contraceptive services (2006-2010) considered the center their usual source of medical care, and 4 in 10 women who obtained care at a family planning center… cite the center as their only source of care.3

Outside of the Alaska Division of Public Health, the Alaska Primary Care Association will assist with coordination of targeted continuing education opportunities for CHCs based on results of a statewide Primary Care Needs Assessment (PCNA). Additionally, Alaska’s governor implemented Medicaid expansion in September 2015, and this undoubtedly will have a positive effect on the percentage of women seen for preventive health services. A Healthy Alaskans 2020 indicator shows that the percentage of adults reporting that they could not afford to see a doctor in the last 12 months was 0.7% (2010) above the 14% target.4

The PCNA survey has been completed and the results will be released by the end of 2015. Targeted continuing education and outreach will begin in 2016, with the other defined steps following that through 2017. An anticipated challenge includes gaining cooperation of all provider types to focus on expanding women’s services to meet the QFP standard.

Kelly Keeter, MPH, is the Adult Health Services Unit and Family Planning Program Manager for the State of Alaska, Dept. of Health & Social Services, Div. of Public Health, Section of Women’s, Children’s & Family Health. Ms. Keeter has managed the State of Alaska’s Title X Family Planning Services Grant Program since 2001 and now oversees the Adult Health Service Unit, which includes the Family Planning, Breast and Cervical Cancer Prevention, and Health and Disabilities Programs.



  1. Kavanaugh ML and Anderson RM. Contraception and Beyond: the Health Benefits of Services Provided at Family Planning Centers. New York: Guttmacher Institute; 2013.
  2. Gavin L, Moskosky S, Carter M et al. Providing Quality Family Planning Services: Recommendations of CDC and the US Office of Population Affairs.  MMWR. 2014; 63 (No. RR-4): 1-54.
  3. Frost JJ. U.S. Women’s Use of Sexual and Reproductive Health Services: Trends, Sources of Care and Factors Associated with Use, 1995–2010. New York: Guttmacher Institute; 2013.
  4. Healthy Alaskans 2020, Leading Health Priority #23.  Accessed October 23, 2015.