History and Development of Contraceptive Use eCQMs

Limitations of previous contraceptive access measures

Beginning in the early 2010s, interest emerged to develop measures to assess contraceptive access as a core component of contraceptive care quality. The first measures developed to assess this, called the Contraceptive Care Measures, are calculated using data from medical claims and measure the percentage of qualifying patients who had a claim in a calendar year for a most or moderately effective method of contraception among all women of reproductive age (15-44). Similar to CU-SINC measures, there is also a submeasure for LARC provision. These measures specifically measure contraceptive provision (e.g. when a provider prescribes or dispenses a method) and are currently in use and were endorsed at the population-level by the federal consensus-based entity (currently Partners for Quality Measurement, previously the National Quality Forum). They are included in the Centers for Medicare and Medicaid (CMS) Child and Adult Core Set of Healthcare Quality Measures. 

However, there are several limitations with the claims-based measures:

  • Claims data do not always accurately identify which contraceptive method a person is using following a visit. This is particularly true for sterilization and LARC methods, which are not captured in administrative claims if provided prior to the latest health care visit or during a previous measurement period.
  • Claims-based measures do not define the population of interest for the measure, which means all eligible patients are included in the denominator, regardless of whether they want contraception or not. 
  • Claims-based measures are designed for calculation in service delivery systems with a fee-for-service model. Therefore, health care facilities that use prospective payment systems, such as Federally Qualified Health Centers (FQHCs), cannot easily employ these measures to evaluate the quality of contraceptive services.

Evolving measures of access: Development of CU-SINC  

CU-SINC was developed to address the limitations of previously developed contraceptive access measures in two ways: 1) by utilizing electronic health record (EHR) data instead of claims data in order to more accurately documents contraceptive use and 2) further defining the target population by including a contraceptive needs screening question. Additionally, because the measures are calculated using EHR data, they can be used within a wide array of health care settings, including systems that do not rely on claims data.

The CU-SINC measures evolve measurement of contraceptive access to more accurately reflect service needs from a person-centered lens. More detail on how this is achieved included below.

Contraceptive use vs provision

Unlike the claims-based measures, which capture only the prescribing or provision of a contraceptive method in the calendar year, the primary CU-SINC eCQMs capture current use of most and moderately effective contraceptive methods to present both a broader and more precise picture of whether patients’ contraceptive needs are met. They include any documented current use or provision documented within the EHR, even if methods are provided in a different calendar year or by a different health care site. This is possible because EHR systems can track ongoing use of a method (e.g., IUD, implant, or sterilization). This more expansive numerator definition captures a broader picture of contraceptive use, as the exclusive focus on provision can misclassify patients who received a method from another facility and continue to use it. For example, if a patient reports to their primary care physician that they are currently use contraceptive pills prescribed by a provider in a sexual and reproductive health care clinic, and their primary care provider records this in the EHR, that patient would be captured in the numerator of the primary CU-SINC measure. This is not possible within the claims-based measures. 

The LARC-SINC submeasure for each measure, however, captures only the provision of LARC in the calendar year as means of assessing  access to these methods. Specifically, the goal of the submeasure is to identify low rates of provision (i.e., below 2%) as an indication of barriers to access.

Optimizing the measure to specify patients with contraceptive need (SINC)

Previously developed measures of contraceptive access have included all qualifying patients (i.e., all women of reproductive age, 15-44) in the measure denominator, regardless of their desire for contraceptive services. The CU-SINC eCQMs utilizes the Self-Identified Need for Contraception (SINC) screening question, “Are you interested in talking about contraceptive care at your visit today?” to refine the measures’ denominators by removing patients who answer “no” to this question during the measurement period. This refinement creates a more patient-centered measure by allowing people to opt out of care without penalizing providers. This also improves the denominator accuracy by specifying the population who would want contraception. This practice is less likely to unintentionally incentivize undesired or coercive contraceptive counseling or provision because providers will know that if someone says “no” to SINC, then they are excluded from the denominator. This is particularly important consideration given the history and risk of ongoing reproductive oppression and contraceptive coercion in the United States directed at women of color and low-income women.

SINC was developed using an equity-informed, stakeholder-involved development process.  For more information on the development of SINC and guidance on how to use SINC at your organization, please visit our SINC screening webpage here. 

Federal measure endorsement process

Development of the CU-SINC measures, formerly known as “SINC-based eCQMs”, began in 2019 and was partially funded by the Office of Population Affairs (OPA). To ensure the measures could be utilized in federal accountability programs and other larger-scale quality measurement initiatives, our team sought endorsement from the federally accredited, Centers for Medicare and Medicaid Services’ Consensus-Based Entity, which at that time was the National Quality Forum (NQF). This endorsement represents the national standard for evaluating and promoting quality measures. We received trial use endorsement from NQF in 2022, with the understanding that a full endorsement application would be submitted within a three-year period. “Trial Use” status allowed the measure to be used in healthcare facilities, while we continued to collect sufficient data to conduct validity and reliability analyses.  

Our team spent two years piloting, socializing, and supporting implementation of SINC. We then worked with two data partners to extract EHR data to analyze the validity and reliability of the measures. After rigorous testing and application preparation, we applied for endorsement in spring 2025 to the current Consensus-Based Entity, Partners for Quality Measurement. CU-SINC measures were fully endorsed by the PQM Recommendations Committee in fall 2025. 

Please visit the PQM’s webpages on CU-SINC (CU-SINC, Postpartum | CU-SINC, Non-Postpartum) for information on measure background and specifications.

For more information on the Contraceptive Use measures: