OB Subgroup Recommendations for the Bree Collaborative

1. 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 7.70.060 , passed in 2007. 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. Thank you! • For more information, contact: Caren Goldenberg, MPH Bree Collaborative Project Manager cgoldenberg@qualityhealth.org