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OPQC Progesterone Project
Action Period Call
May 28, 2015
12:15-1:15 PM ET
Welcome!
Please do not put the call on hold, but please do mute your line!
• Use the MUTE button on your phone or
• *6 to place the call on MUTE and *6 to come off of MUTE
Progesterone Teams • AGMC's Women's Health Clinic
• Aultman Physician Center-OB/GYN Clinic
• Brown County Women's Health
• Center for Women’s Health, University of Cincinnati Medical Center
• Doctors Hospital Women's Health Center
• Faculty Medical Center—OB Resident Clinic GSH (TriHealth)
• Fairview Perinatal Department (Cleveland Clinic)
• Five Rivers Health Centers, Center for Women's Health (Miami Valley Hospital)
• MacDonald Women's Hospital Clinic (Family Practice and OB Faculty Clinic)
• Maternal Fetal Medicine at Hillcrest Hospital Atrium (Cleveland Clinic)
• Mercy OB/GYN Associates Family Care Center/ MFM Clinic
• MetroHealth Women's Clinic
• Mount Carmel St. Ann’s OB/GYN Clinic
• Mt. Carmel West Outpatient Clinic
• OSU McCampbell Clinic
• OSU Martha Morehouse MFM
• Outpatient Care Center at Grant Medical Center
• ProMedica Center for Health Services – Women’s Services (ProMedica Toledo Hospital)
• Riverside OB Community Care Clinic/ MFM Consultative Practice
• St. Elizabeth Boardman’s Health Center
• Tri-State Maternal Fetal Medicine Associates, Inc.
• Women's Health Center at Summa Akron City Hospital
12:15 PM
Welcome and objectives Introductions / KDD revisions
Martha Rome
12:25 From the Desk of Ohio’s Progesterone Navigator
Hetty Walker
12:35 Monthly Aggregate Data Jay Iams
12:40 Rapid Fire: What are you
learning from the data? Teams
1:05 Medicaid Managed Care Communication Form Test
Mike Marcotte
1:10 PM Wrap Up and Next Steps Martha Rome
Agenda
Objectives for Today’s Call
• Explore opportunities to understand data collected and graphs
• Review work with Medicaid to test a new Communication Form / PRAF
Introductions to “new” OB OPQC
team members
• Cathy Jaworski MSN RN-BC
BEACON Quality Improvement Coordinator
• Stephanie Buckler – Specialist, Project
Management OPQC
• Jennifer M. Jones (Dusing) –
Coordinator, Project Management OPQC
DRIVERS
Revision Date: 05-15
PROGESTERONE PROJECT KEY DRIVER DIAGRAM
SMART AIM
BY July 1, 2016,
DECREASE THE
RATE OF
PREMATURE
BIRTHS in Ohio
less than 37 weeks
by 10%, and less
than 32 weeks by
10%
GLOBAL AIM
IMPROVE NEWBORN
OUTCOMES BY
REDUCING
PREMATURE BIRTHS
Consistent and
early recognition of
prior preterm birth
Expedite
progesterone
supplementation
Adopt a cervical
length ultrasound
screening protocol
INTERVENTIONS
• Educate on benefits of progesterone and
use evidence-based counseling methods
• Involve key support individuals
• Connect women to insurance, home
care, social services, etc. to ensure
progesterone available &administered
• Work with Medicaid and Medicaid Plans
to identify women at risk and reduce
administrative barriers
• Create a written protocol for identified
candidates
• Start progesterone as soon as possible
(according to ACOG and SMFM
guidelines) after identification of
eligible woman
• Screen women for OB history of
preterm birth
• Align and communicate with EDs, WIC,
etc. to screen and refer when history of
preterm birth
• Facilitate rapid new OB appointments
• Postpartum counseling on
progesterone for those eligible in next
pregnancy
• Use sonographers trained in cervical
length measurement
• Develop a practice protocol to
selectively or universally screen
cervical length (consider population
risk)
Customize patient
care to start and
maintain women on
progesterone
MEDICAID AND BRANDED
PROGESTERONE -- HETTY
WALKER
Update: Rx of Makena®
for Patients on Straight Medicaid (Medicaid Fee For Service)
• New Criteria - Makena® Rx Requires ALL of the following:
1. History of prior preterm birth
2. Singleton pregnancy (no multiples)
3. Initiate no earlier than 16 weeks, no later than 24 weeks
NO Prior Authorization !
• Compounded 17 P or Vaginal Progesterone no longer preferred by Medicaid FFS
• Injection administered by a trained caregiver (may be family member)
• Approved through 36 weeks gestation
• Home care is covered if the company providing it is contracted with Medicaid – Alere is currently not contracted with Medicaid but is in process
Note: Any drug administered in office is “Buy and Bill” = a medical claim – bundle cost of drug + In Office Administration Fee, NO Prior Authorization !
Questions? – OPQC.net: click on Provider / scroll to section Progesterone as Prevention of Preterm
Birth and you’ll see the continually updated Progesterone Coverage Chart (Ohio)
– Or call Hetty Walker 614-293-8949 or email [email protected]
MONTHLY AGGREGATE DATA
– DR. JAY IAMS
Your Turn: Rapid Fire Reports
• What is your data telling you?
– Have you improved in any areas?
– What might help your team “move the dial”?
Progesterone Teams • Aultman Physician Center-OB/GYN Clinic
• MacDonald Women's Hospital Clinic (Family Practice and OB Faculty Clinic)
• Center for Women’s Health, University of Cincinnati Medical Center
• Doctors Hospital Women's Health Center
• Faculty Medical Center—OB Resident Clinic GSH (TriHealth)
• Fairview Perinatal Department (Cleveland Clinic)
• St. Elizabeth Boardman’s Health Center
• Five Rivers Health Centers, Center for Women's Health (Miami Valley Hospital)
• Maternal Fetal Medicine at Hillcrest Hospital Atrium (Cleveland Clinic)
• Brown County Women's Health
• Outpatient Care Center at Grant Medical Center
• MetroHealth Women's Clinic
• Mt. Carmel West Outpatient Clinic
• OSU McCampbell Clinic
• Mercy OB/GYN Associates Family Care Center/ MFM Clinic
• ProMedica Center for Health Services – Women’s Services (ProMedica Toledo Hospital)
• AGMC's Women's Health Clinic
• Riverside OB Community Care Clinic/ MFM Consultative Practice
• Tri-State Maternal Fetal Medicine Associates, Inc.
• OSU Martha Morehouse MFM
• Women's Health Center at Summa Akron City Hospital
• Mount Carmel St. Ann’s OB/GYN Clinic
COMMUNICATION FORM
PDSA– DR. MIKE MARCOTTE
Communication Form/PRAF
THANK YOU!
• Medicaid is testing a standard risk identification form that will eventually be used by all of the MMO’s & Medicaid FFS
• OPQC teams were asked to pilot/review form
• OPQC will review your responses with Medicaid
• Next PDSA: use form to streamline care first in 6 sites
Do
Study Act
Plan
Please Complete the Late Start
Investigations
• Review the list generated by the Data Team for Candidates that started Progesterone after 20 weeks
• Choose candidates that came in before 20 weeks, if you have them. If not, choose any 5 and ask yourselves why they came in late!
Next Steps
• Complete the Monthly Site Profile by June 5 https://portal.opqc.net/Progesterone/SitePages/Home.a
spx
• Don’t forget to complete GA after birth!
• The Monthly Progress Report (MPR) link was
sent to your Key Contact last week. Please
complete them by June 5.
• Complete the Late Start Investigations (5)
https://redcap.research.cchmc.org/surveys/?s=
NtbGiD5bvu
Roll Call: If you didn’t identify yourself on the roll call
please sign in on the call in the Questions box
Thank you for joining the call and sharing your work!