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

2. 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

3. 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”

4. 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

5. 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 , passed in Unclear if this work would meet state’s definition

6. 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

7. 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

8. Recommended Strategies
Many studies have shown narrowly focused, single interventions unlikely to produce lasting results
Necessary to pursue several strategies at once

9. 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

10. 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

11. 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

12. 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)

13. Bree Collaborative Project Manager
Thank you!
For more information, contact:
Caren Goldenberg, MPH
Bree Collaborative Project Manager