The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Tag: BCBSM (page 1 of 4)

Improving Maternal and Neonatal Outcomes through the Obstetrics Initiative

Nina Bobowski, MPH is the Obstetrics Initiative Project Manager

One in three women who give birth in the United States deliver by cesarean. Cesarean delivery can reduce morbidity and be life-saving for mother and baby, but it is associated with higher rates of complications and higher costs than vaginal delivery. Rates of cesarean delivery, both nationally and in Michigan, increased 50% between 1997 and 2008[1]. High rates of cesarean delivery are an increasingly recognized patient safety concern. Blue Cross Blue Shield of Michigan (BCBSM) has invested in this effort through a statewide initiative to safely reduce the use of cesarean delivery where appropriate.

At the November 2017 collaborative-wide meeting, MVC hospitals were introduced to the new Obstetrics Initiative (OBI). OBI is part of BCBSM’s Value Partnership collaborative quality initiative (CQI) program and is closely partnered with MVC. OBI is a physician-led initiative quality improvement project addressing variation in obstetric care, specifically supporting vaginal birth and safely reducing cesarean delivery.

OBI was established to help Michigan become a national leader in improving the quality of maternity care.  Cesarean delivery rates are an important quality issue for patients and maternity clinicians alike.  OBI’s first initiative is safely lowering the cesarean section rate among low-risk patients.

How can your hospital benefit from joining the Obstetrics Initiative?

OBI provides the framework to leverage the data available in MVC to determine your hospital’s cesarean delivery and vaginal delivery rates for “low”[2] and “non-low” risk groups, and to assess maternal and fetal outcomes with proper risk adjustment. There is no one strategy to address all practice patterns around the use of cesarean delivery but engaging in discussion regarding these data is a critical step in understanding why such variation exists and how we can respond. The significant variation in cesarean delivery rates across hospitals suggests that there is an opportunity to reduce use of cesarean section.

OBI catalyzes quality improvement efforts in three key ways.

  1. OBI provides an Obstetrics Report (michiganvalue.org) to help you understand how your hospital’s vaginal and cesarean delivery rates compare to peer hospitals across the state.
  2. OBI will offer technical support to help your hospital implement strategies to safely lower the cesarean rate.
  3. OBI will engage hospitals in peer-to-peer quality improvement efforts, so we can all benefit from each other’s successes.

Based on prior successes in state-wide obstetric quality collaboratives[3], we are confident that these three activities can help us improve the quality of obstetric care for the women and families we serve.

What does the Obstetrics Report show my hospital?

OBI is excited to provide resources to support your obstetric quality improvement efforts.  The OBI Reports (www.michiganvalue.org) provide rich data to understand your hospital’s cesarean delivery and vaginal delivery rates for “low” and “non-low” risk groups of patients[4], and to assess maternal and fetal outcomes after adjusting for your patient population. These reports can also help hospitals monitor maternal and neonatal outcomes after implementing interventions to improve maternity care quality and support vaginal birth.

How can your hospital participate in the Ob Initiative?

Become an obstetric champion at your hospital for the Ob Initiative. Both nursing and physician champions are core components of successful implementation and leading culture change. Nursing champions play a central role in testing, implementing, coordinating, and disseminating clinical practice refinement and changes. Physicians and midwife champions are particularly important as they make the definitive diagnostic and treatment decisions.

Supported by OBI, these champions will enable peer-to-peer Michigan hospital efforts regarding rates of vaginal and cesarean delivery as well as maternal and neonatal outcomes. OBI will engage these champions and hospital stakeholders in understanding and effectively utilizing their Obstetrics Report to improve safe birth practices.

OBI will:

  • Engage champions and hospital stakeholders in understanding and effectively utilizing their Obstetrics Report to improve safe birth practices;
  • Initiate hospital site visits and workgroups to identify root causes of variation and opportunities for improvement in obstetric care;
  • Support hospitals to develop their own site-specific goals with regards to obstetric care, specifically around safely reducing cesarean births and supporting vaginal births; and
  • Identify and support dissemination of strategies shown to promote vaginal births and reduce cesarean delivery rates for low-risk births while working toward the goal of safe delivery practices with continued good outcomes for infants and women.

Please join us as we work together to improve safe delivery practices across the state.

If you would like more information about OBI or are interested in participating, please contact the OBI Project Manager, Nina Bobowski at npbo@med.umich.edu.

Sources:

[1] E.L. Barber, L.S. Lundsberg, K. Belanger, C.M. Pettker, E.F. Funai, J.L. Illuzzi. Indications contributing to the increasing cesarean delivery rate Obstet Gynecol, 118 (2011), pp. 29-38

[2] Armstrong JC, Kozhimannil KB, McDermott P, Saade GR, Srinivas SK. ; Society for Maternal-Fetal Medicine Health Policy Committee. Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. Am J Obstet Gynecol 2016; 214 (02) 153-163

[3] https://www.cmqcc.org/qi-initiatives/promoting-vaginal-birth

[4] Armstrong JC, Kozhimannil KB, McDermott P, Saade GR, Srinivas SK. ; Society for Maternal-Fetal Medicine Health Policy Committee. Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. Am J Obstet Gynecol 2016; 214 (02) 153-163

 

Going National with The Michigan Model of Collaborative Quality Initiatives

Scott Regenbogen

Dr. Regenbogen is the MVC Co-Director

Over the last 10-plus years, the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships have grown to include, among other programs, 17 Collaborative Quality Initiatives (CQI). The clinical focus of the CQIs ranges from cardiology to spine surgery to radiation and many others. This “Michigan Model” of collaboration, pay-for-participation, and statewide, population-based quality improvement has yielded wide-ranging improvements, as reported several years ago.

Still, the regional collaboratives model has not spread widely beyond Michigan. Last month, at the inaugural summit of the Center of Excellence for Collaborative Quality Improvement, discussion focused on the challenges of securing financial support for regional collaboratives. Several other states—including Tennessee, South Carolina, Illinois, and Pennsylvania—have multi-hospital improvement initiatives around surgical care, but on a smaller scale than in Michigan. Like Michigan’s, all of these CQIs are supported by a regional Blue Cross Blue Shield insurer. In a commentary in this week’s JAMA Surgery, the leaders of the Michigan Surgical Quality Collaborative argue that an all-payer strategy, including investment from the Centers for Medicare and Medicaid Services (CMS), is needed in order to replicate the Michigan approach to care improvement.

To date, BCBSM has been the sole third-party funding source for the CQIs. Yet, the efforts of each collaborative have been payer-naïve—the benefits accrue to all patients regardless of their insurance coverage. In the Michigan Value Collaborative, we analyze payment data for individuals insured by both BSBSM and Medicare, and will soon expand to include Medicaid beneficiaries as well. And even in states like Michigan, where BCBSM handles quite a large portion of the commercial insurance market, CMS still remains the truly dominant payer, once we consider Medicare and Medicaid in all of their various forms.

This week’s JAMA Surgery Viewpoint considers how CMS could partner with private payers in support of regional collaboratives. Such a partnership could allow Michigan to become a model for the rest of the country. Under the new requirements for MACRA, physicians may satisfy reporting requirements through Qualified Clinical Data Registries. But what if active participation in a proactive CQI became a central part of all medical care in this country, and was supported by CMS? If this degree of dissemination could be achieved, CMS could catalyze innovative care delivery improvement on a far greater scale.

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