Obstetrical Pay For Performance

Introduction The Department of Social Services is introducing a Pay for Performance (P4P) Program in obstetrics care, beginning August 1, The purpose of this program is to improve the care for pregnant women and the outcomes of their newborns covered under the HUSKY Health programs. A total of $1.2 million was appropriated by the Connecticut General Assembly to be paid to providers of obstetric care in State Fiscal Year Obstetrical P4P payments are in addition to current fee for service payments.

Eligible Providers Providers eligible to participate in the obstetric P4P Program are providers currently enrolled as family medicine physicians, obstetrician/gynecologists, obstetric nurse practitioners, family medicine nurse practitioners, physician assistants and certified nurse midwives enrolled in the Connecticut Medical Assistance Program (CMAP) network and providing obstetric care to eligible Husky Health and Charter Oak Health Plan clients.

Performance Measures The following performance measures (with their associated point values) are those for which the Department will provide incentive payments: Performance MeasurePoint Value Timely completion (within 14 days) of online obstetrics prenatal and post- partum notification forms 5 A first obstetric visit within 14 days after confirmation of pregnancy 25 At least one postpartum visit within 21 – 56 days after delivery 25 Full-term, vaginal delivery after spontaneous labor whenever medically possible. 30 Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor NOTE: 30 points if used when indicated; 30 NOTE: 30 points subtracted from the provider’s total if NOT used when clinically indicated. -30

Evaluating Provider Performance  Data on provider’s performance on the above measures will be collected from claims and from the obstetrics notification forms.  Only episodes of care for which providers use the online obstetrics notification forms will be eligible for the P4P Program.

Data Collection Online OB Notification Forms Measure: Timely completion (within 14 days) of online obstetrics prenatal and post-partum notification forms Online OB Notification Form Question(s) Points are awarded if the online OB notification is completed within 14 days of the first prenatal visit.

Data Collection Online OB Notification Forms Measure: At least one postpartum visit within 21 – 56 days after delivery Online OB Notification Form Question(s) Points awarded if a postpartum visit occurred within days of the actual date of delivery

Data Collection Online OB Notification Forms Measure: A first obstetric visit within 14 days after confirmation of pregnancy Online OB Notification Form Question(s) Points awarded if the first prenatal visit date and the pregnancy confirmation date is within 14 days.

Data Collection Online OB Notification Forms Measure: Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor Online OB Notification Form Question(s) Both claims and the above OB notification form questions will be utilized to award points for this measure.

Data Collection Online OB Notification Forms Measure: Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor Note: 30 points subtracted from the provider’s total if NOT used when clinically indicated. Current ACOG guidelines for the use of 17-alpha hydroxyprogesterone will be used as a reference for this measure.

Data Collection Online OB Notification Forms Measure: Full-term, vaginal delivery after spontaneous labor whenever medically possible. Online OB Notification Form Question(s)

CLICK ON “For Providers” Accessing the Provider Portal & OB Notification Forms

CLICK ON Accessing the Provider Portal & OB Notification Forms

Please click on the icon below to access a “Provider Portal & OB Notification Form How To Guide”

Overview OB Notification Forms There are two types of OB Notification Forms Prenatal Providers should complete this form online within 14 days of the member’s first prenatal visit. Postpartum Providers should complete this form online within 14 days of the member’s first postpartum visit. Note: Interconception counseling should be a component of this PP visit.

Overview OB Notification Provider Resources Within the Prenatal OB form there are available evidence based resources for the provider to use with their patients.

OB Notification Form Questions Patient/Member Demographics

OB Notification Form Questions Pregnancy History Enter the appropriate numerical answer

OB Notification Form Questions Member/Patient Contact and First Visit Enter the appropriate dates.

OB Notification Form Questions OB Provider Information & Hospital Enter the Primary (or Attending)Prenatal Provider’s Name Enter the name of the practice (This can be a clinic, private practice, group practice or FQHC)

OB Notification Form Questions Social Needs Assessment & Risk Answer Yes or No Choose the appropriate drop down choice

OB Notification Form Questions Risk Identification Choose the appropriate drop down choice Note: The provider can identify up to 4 risk factors.

OB Notification Form Questions Behavioral Health Needs Choose the appropriate drop down choice Note: The provider can identify up to 4 risk factors. Answer Yes, No or Pt refused

OB Notification Form Questions 17 –Hydroxyprogestrone Caproate Screening Answer Yes or No

OB Notification Form Questions Medications Please type in all of the patient/member’s current medications Note: The intensive care management team will use this information for medication reconciliation

Submitting the Form Enter the name of the person completing the form Submit Date auto populates to the date the form was completed & submitted Click on this button ( ) to submit the form. Note: This step must be done to submit the form

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