Achieving the Triple Aim through Integration of Preventive Reproductive Health Care

January 15, 2015   |  Tags: Blog   |  Tags: Contraception , Screening , CCO Metric , Population Health
Michele Stranger Hunter, Oregon Foundation for Reproductive Health

The recent initiative by the Oregon Foundation for Reproductive Health (OFRH), One Key Question®, aims to better integrate preventive reproductive care into primary care. One Key Question® involves screening women of reproductive age by asking “Would you like to become pregnant in the next year?” and providing the appropriate follow up care.

The concept of One Key Question® is simple but the impact could be dramatic: more pregnancies that are wanted, planned and as healthy as possible.

Unintended pregnancy is a decades-old community health problem that has negative consequences for the health and well-being of the mother and infant. Introducing One Key Question® into your health center or practice helps to achieve the ‘triple aim’ of health care transformation.

This non-judgmental question brings pregnancy intention screening directly into primary care and opens the door to providing preconception and/or contraceptive care in a patient-centric way. It goes beyond simply asking if a patient is using contraception and starts a conversation that allows women to answer honestly about their reproductive goals.

Health care providers are busier than ever today, and many are initially concerned about asking a question that might take too much time and resources to address. What clinicians do find, however, is that One Key Question® actually helps them to effectively identify women who really need preventive reproductive health care. For example: among women who are undecided about pregnancy, intention screening can identify urgent health needs that may otherwise go undetected, such as depression, violence in the home or substance abuse, which may be underlying factors to the indecision and can lead to negative pregnancy outcomes.

Oregon health care providers, community stakeholders and consumers are all very aware of the need to dramatically improve access to preventive health care without increasing costs. Pregnancy and childbearing outcomes carry the potential for lifelong positive or negative health effects. Pregnancy outcomes are closely related to maternal child health disparities, with low-income women of color experiencing the most compromised health before conception and disproportionately high instances of low birth weight and preterm babies, maternal and infant mortality and other related outcomes.

Ensuring more women receive preventive reproductive health care can be the start of improved health outcomes and lowering costs to the health care system.

One Key Question® is so important to women's health that the Metrics and Scoring Committee voted to make “Effective contraceptive use among women at risk for unintended pregnancy” an incentivized metric for Coordinated Care Organizations (CCOs) for 2015. By moving this metric to be incentivized, Oregon is making a commitment to prioritizing women’s preventive reproductive health needs. OFRH provided critical testimony to the Committee to ensure this metric was moved forward, making Oregon the first in the nation.

One Key Question® is the Oregon Health Authority’s recommended approach for pregnancy intention screening in Oregon and is highlighted as the number one strategy for providers to use to meet this metric.

We recognize it takes a concerted effort to incorporate a new screening and to change service delivery patterns. OFRH works closely with health care centers to provide custom consultations for implementing One Key Question® into their routine practice to ensure they are successful! OFRH brings implementation experience from a wide range of practice settings, to share solutions to common barriers as well as operational templates of clinic flow, electronic health records examples, and up-to-date educational materials for patients. Most implementation sites track whether there is an increase in contraceptive care, an increase in the number of women choosing to use more effective contraceptive methods, and an increase in the use of folic acid as indicators that a woman was counseled about preconception or contraception care based on her response to One Key Question®.


The Oregon Foundation for Reproductive Health (OFRH) is a non-profit dedicated to improving access to comprehensive reproductive health care, such as preventing unintended pregnancy and planning healthy families. We are committed to advancing reproductive rights and advocating for reproductive health equity in all Oregon communities. There are 30 professional organizations that endorse One Key Question®, including all the primary care associations in Oregon. Write to for more information.


Michele Stranger Hunter is the Executive Director of the Oregon Foundation for Reproductive Health. Michele has a Master’s in Education Administration and has worked in the health care and human services industries for over 30 years. She has seasoned organizational leadership experience in reproductive health care services in both the private and public sectors. As an organizational consultant to many health care organizations, Michele has helped them improve their organization effectiveness as well as secure funding.