PQCNC SIVB LS 1 Statewide Initiatives

8/7/2019 PQCNC SIVB LS 1 Statewide Initiatives

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Birth Certificate

Pregnancy Medical Homes


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2003 standard U.S. birth certificate

NC is 38th state to implement; all hospitals on boardby December 2010 Web-based data entry program Old birth certificate has 43 questions

New birth certificate has 58 questions, 9-pageworksheet of clinical info, 5-page mothers worksheet Almost all of the new data is clinical

IVF, induction, augmentation, chronic hypertension vs.gestational

More information on www.pqcnc.org, including two-page worksheet for clinical information

Good birth certificate data benefit all of us!
http://www.pqcnc.org/http://www.pqcnc.org/


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A partnership with

Community Care of NorthCarolina, Division of Medical

Assistance and Division of

Public Health


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Improve birth outcomes in North Carolina by

providing evidence-based, high-quality

maternity care to Medicaid patients

Improve stewardship of limited perinatalhealth resources

Reduce preterm birth rate, rate of low birth

weight, cesarean section rate


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DMA/DPH/CCNC steering committee

DMA project team

CCNC OB workgroup

Perinatologists, obstetricians, midwife, family medicine Local health departments

DPH Womens Health Branch

Division of MH/DD/SA

Division of Medical Assistance Local CCNC network leadership

DPH Womens Health Branch team


6/12

AccessCare Network Sites

AccessCare Network Counties

Access II Care of Western NC

Access III of Lower Cape Fear

Southern Piedmont Community Care Plan

Community Care Plan of Eastern NC

Community Health Partners

Northern Piedmont Community CarePartnership for Health Management

Sandhills Community Care Network

Community Care of Wake and Johnston Counties

Carolina Collaborative Comm. Care

Carolina Community Health Partnership

Comm. Care Partners of Gtr. Mecklenburg

Central Piedmont Access II

Central Care Health Network


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Any current provider of maternity care will be ableto sign an agreement with a CCNC network tobecome a Pregnancy Home:

OB/GYN practices

Family medicine Certified nurse midwives

Nurse practitioners

Local health departments

Federally qualified health centers

May or may not also be a CCNC/Carolina AccessPrimary Care Medical Home


8/12

Provide comprehensive, coordinated maternity care to

pregnant Medicaid patients and to allow chart audits for theevaluation purposes for quality improvement measures

Four performance measures:

No elective deliveries


9/12

Data-driven approach to improving care and outcomes,including practice-based report with comparison data

Incentives:

Increased rate of reimbursement for global fee for vaginal

deliveries to equal that of c-section global fee (similarincrease for providers who do not bill global fee)

$50 incentive payment for initial risk screening

$150 incentive payment for postpartum visit

No prior authorization required for OB ultrasounds (but still

must register with MedSolutions) Support from CCNC network/NCCCN, Inc.

Example: pharmacy working group re: 17P and long-actingcontraceptives


10/12

Network is accountable to DMA for outcomes of thisinitiative (pregnancy medical homes and pregnancy caremanagement)

Each network to have an OB team:

OB coordinator (nurse) and OB clinical champion (physician)

OB team will:

educate and recruit practices

work with providers and other local agencies to make thesystem changes necessary for program

provide technical and clinical support to participatingpregnancy homes and to OB case management


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Risk criteria include acombination of medicalrisk, psychosocial factors,and utilization (or lackthereof)

Positive risk screen willtrigger case managementassessment

Risk screening to beperformed at first OB visit;follow-up screen at end of2nd trimester and anytimenew risk factor may bepresent

Priority risk factors: History of preterm birth

History of LBW

Substance abuse

Tobacco use Chronic disease which may

complicate pregnancy

Unsafe living environment

Late entry to prenatal care

Missing 2 or more prenatal appts


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Partnership with public health

Change from current MCC Program paradigm of all

Medicaid-eligible patients to focusing on those with

risk factors for poor birth outcome Care managers assigned to cover OB practices

Care managers will use CCNCs Case Management

Information System software

Coordination with the CCNC networks OB team

Support from state DPH team

Documents

PQCNC SIVB LS 1 Statewide Initiatives