OB Subgroup Recommendations for the Bree Collaborative Jan 30, 2012 OB Subgroup Recommendations for the Bree Collaborative

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)

Bree Collaborative Project Manager Thank you! For more information, contact: Caren Goldenberg, MPH Bree Collaborative Project Manager cgoldenberg@qualityhealth.org