OB Subgroup Recommendations for the Bree Collaborative

Jan 30, 2012

Subgroup Members

Theresa Helle, Manager Health Care Quality and Efficiency Initiatives, the Boeing Company

Ellen Kauffman, MD, OB-COAP Medical Director Roger Rowles, MD, Yakima Memorial OB-GYN Dale Reisner, MD, Swedish Hospital perinatologist Carl Olden, MD, Family Practice in Yakima and

President, WA Academy of Family Physicians Mary Kay O’Neill, MD, PNW Medical Director,

CIGNA

What’s happening now?

Perinatal Advisory Collaborative (Dr. Rowles to report)

OB-COAP (Obstetrics Clinical Outcomes Assessment Program) (Dr. Kauffman to report)

Leapfrog Call to Action Shared medical decision making State “report cards”

Leapfrog Call to Action

Current report applies to hospitals that voluntarily supply data to Leapfrog (19 WA hospitals)

IHI/Leapfrog national webinars for providers Catalyst for Payment Reform has model health

plan contract language to help purchasers signal expectations to health plans about how they should improve payment practices for maternity care

Aetna, CIGNA, UnitedHealthcare and Wellpoint continuing a public awareness campaign to expectant women

Shared Medical Decision Making

“Expecting More” partnership between Childbirth Connection (maternity care advocacy group) and Foundation for Shared Medical Decision Making, to develop patient decision aids for maternity care

Interest in piloting in WA RCW 7.70.060 , passed in 2007.

Unclear if this work would meet state’s definition

State report card program

Reports based on birth certificate data

Includes c-section, VBAC, low birthweight, and induction rates

Will be reported by facility and available on secure website

Plan is to encourage facilities to drill down to provider level, then use forthcoming OHSU toolkit to make improvements

Recommended Goal:“Reduce first-time c-sections.”•Since inductions increase the likelihood of a c-section, interventions that reduce inductions at any gestational age still address this goal•Interventions to increase VBAC do not fall under this goal, but are worthy and will still be pursued by other groups•Somewhat narrow goal is necessary given our time frame•The goal is “reduction”, recognizing that some are indeed medically necessary

Recommended Strategies

Many studies have shown narrowly focused, single interventions unlikely to produce lasting results

Necessary to pursue several strategies at once

1. Support improved data collection and analysis

Encourage all hospitals that perform deliveries to participate in OB-COAP (or a homegrown robust reporting system, if a hospital has one)

Data would be available to dig down into causes of variation across the state

OB-COAP does not require ongoing oversight by the Bree, but does provide a means of ongoing quality improvement

2. Take advantage of existing toolkits

This includes the CA Maternal Quality Care Collaborative, the March of Dimes, Childbirth Connection, and the forthcoming toolkit from OHSU

Toolkits can be made available to any hospital- all are free of charge

Can be useful guides to behavior change, once variation has been identified

3.Public Education Campaign & Patient Decision Aid Promotion

Explore partnership with March of Dimes, based on their successful initiatives elsewhere

Explore statewide pilot of patient decision aids being developed by “Expecting More” program

4. Explore potential financial incentives for behavior change

Many models exist Start with survey of WA plans to see

what is currently being tried Possibility of modeling on Minnesota

(bundled payment for full episode of maternity care for low-risk women, plus denial of payment for unecessary births before 39 weeks)

Thank you!

For more information, contact:Caren Goldenberg, MPH

Bree Collaborative Project Managercgoldenberg@qualityhealth.org