1. Collaborative Improvement & Innovation Network to Reduce Infant Mortality (CoIIN) MA State Team Update Audra R. Meadows, MD, MPH Brigham & Women's Hospital OB/GYN Vice Co-Chair, MPQC October 21, 2015

2. MPQC / CoIIN Collaboration CoIIN 2015 HRSA led public-private partnership to reduce infant mortality and improve birth outcomes Incorporate improvement science and engage participants in the full spectrum of change MPQC 2014 Formed a Premature Birth Prevention Committee Focus on Progesterone Collaborate with MA CoIIN given shared priorities Our work: Define the problem and craft an intervention Implement and evaluate the intervention Diffuse/adapt effective innovations in new settings

3. State Strategy Selection (n= number of states) Improve Safe Sleep Practices (n = 37) Reduce smoking before, during and/or after pregnancy (n = 21) Pre & Interconception Care Promote optimal women’s health before, after and in between pregnancies during Postpartum Visits & Adolescent Well Visits (n = 29) Social Determinants of Health Incorporating evidence-based policies/programs & place-based strategies to improve equity in birth outcomes (n = 23) Prevent Pre and Early Term Births (n = 21) Risk Appropriate Perinatal Care (Perinatal Regionalization) Increase the deliver of higher-risk infants and mothers at appropriate level facilities (n = 14)

4. MA CoIIN Goals by 2016 1.Promote Safe Sleep 2.Reduce Preterm Birth 1.Decrease Early Elective Delivery rates in hospitals with rate >2.5% 2.Increase administration of progesterone among mothers with prior preterm birth and at risk for preterm birth 3.Establish enhanced reimbursement rates for Centering Pregnancy 3.Address Social Determinants of Health

5. MA CoIIN Prevent Pre/Early Term Births Workgroup Debbie Allen Boston Public Health Commission Wendy Barr, MD American Academy of Family Physicians, MA Chapter, Greater Lawrence Family Health Center Barrie Baker Tufts Health Plan – Network Health Mary Ellen Boisvert BID Plymouth Beth Buxton Department of Public Health Alice Fiddian Green Project Baby Springfield Emily Lu Department of Public Health Audra Meadows, MD Brigham & Women’s Hospital Beth Monahan, CNM Boston Medical Center Colleen Senterfitt, CNM Centering Healthcare Institute Sara Shields, MD UMass Medical Center Laura Pizza Plum Plum Health Care Consulting Christina Ratleff Department of Public Health Bonnie Glass, RN, MN MA Perinatal Quality Collaborative ; UMass Dartmouth Carla McGowan Neighborhood Health Plan Ellen Sharpe Neighborhood Health Plan Glenn Markenson, MD Baystate Medical Center Hafsatou (Fifi) Diop, MD, MPH Department of Public Health Monica Le, MD, MPH MassHealth Mark Manning, MD UMass Memorial Munish Gupta, MD BID Medical Center Sarah Stone Department of Public Health

6. MA CoIIN Prevent Pre/Early Term Births Strategies 1) Reduce Early Elective Deliveries (EED) Recognize those birth hospitals who have met the state goal of EED >2.5% by implementing the MOD Banner Program According to Leapfrog (Jan 2015), there are currently 9 hospitals with rates above 2.5% CoIIN/MPQC partnership to provide TA to these hospitals to reduce their rates

7. MA CoIIN Prevent Pre/Early Term Births Strategies 2) Increase Progesterone Administration  Increase use of progesterone among mothers who have already experienced a preterm birth  Increase provider awareness to improve knowledge and adherence Conduct a provider survey to learn about barriers to progesterone administration Develop a provider tool kit that will include: Sample protocol on progesterone use (evidence based) MassHealth spreadsheet listing covered progesterone therapies by plan Hospital/Practice Self Assessment Tool Educational materials

8. Barriers to Progesterone Use: Access – Clinical uncertainty on what to order and where – Prior authorization – Cost Late Entry into Prenatal Care Administration Inappropriate/Inadequate Use

9. Noted Survey Findings: 52 respondents (73% OB/CNM, 19% RN/NP, 4% Family Med) 50% Boston 80% >10 years of practice 65% Hospital Based, 22% Private office, 4% CHC

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15. When asked ‘what would improve efficient administration of progesterone to eligible pregnant women in your practice”? – 78% of respondents indicated Streamline insurance authorization process, as VERY HELPFUL – Followed by, Universal insurance coverage for 17-P home administration (74%) – And, Free patient educational materials (52%) n=47

16. MA CoIIN Prevent Pre/Early Term Births Strategies 3) Centering Pregnancy Encourage payors (MassHealth, commercial and private insurance) to make an incentive payment to the medical providers for each patient who attends a Centering Pregnancy session and another payment if the patient attends five or more sessions Increased reimbursement will increase the number of CP sites across the state. In addition, it will also improve access and utilization. Work with Medicaid to adopt Pay for Performance Incentives for CP

17. Thank you! It is the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed. Charles Darwin