Birth Outcomes Initiative

1. Birth Outcomes Initiative Rebekah E. Gee MD MPH FACOG, Director

2. Louisiana Rankings Source: Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National vital statistics reports; vol 59 no 1. Hyattsville, MD: National Center for Health Statistics. 2010.

3. Birth Outcomes Initiative Announcement and Kick-Off Event “Prematurity: What are we going to do about it? Day”

5. Birth Outcomes Priority Areas • Increase Patient Safety and Quality of Care • Pilot and expand access to Interconception Care Coordination • Institute statewide comprehensive Behavioral Health screening and brief intervention for pregnant women in Medicaid • Increase Data Capacity and Performance Measurement

6. Patient Safety and Quality of Care To create a culture of continuous quality improvement and safety in Louisiana’s birthing hospitals • 39 week statewide initiative • 20 of 23 major birthing hospitals have signed pledge to end elective deliveries <39 weeks • Statewide perinatal quality improvement by 16 of 23 largest birthing hospitals with IHI • Malpractice reduction for 39 week training with major insurance carrier LAMMICO • Payment reform rule written; “never event” for physician and hospital • March of Dimes, Hospital Association, ACOG and Medical Society partnerships • Vermont Oxford NICU collaborative • DHH Birthing Centers of Excellence • Five star programs with goal to attach payment incentives • National Partnerships (March of Dimes, Milbank fund, NAPH, ASTHO)

7. Care Coordination To ensure that every woman in Louisiana has a reproductive life plan and that high risk individuals receive targeted case management • CMS has approved waiver for primary care up to 200% poverty for greater New Orleans four parish (county) area. • Layered onto primary care, an Interpregnancy Care (IPC) case management program is being developed pending final CMS approval • IPC program is based on the CMS Georgia Family Planning waiver and provides care and case management for women who deliver a stillborn, premature, or low or very low birth weight infant. • Collaboration with New Orleans Department of Health and Healthy Start as care coordinator and support to clinics for reproductive life plan and preconception health assessment. • Proof of concept for statewide expansion through development of alternative payment mechanisms through healthy start of public health nurses

8. Behavioral Health Assess and improve the behavioral health of Louisiana’s pregnant women • Screening for substance use, depression and violence for every pregnant woman in Medicaid through provider payment • Online interactive tool in development with goal to generate data, automatic referrals and support brief intervention • Program created by moving funds from pilot (MCH, Behavioral health) into Medicaid for match • Tool in development is a merger of previous program (5Ps) with WHO ASSIST screening tool • Statewide behavioral health resource guide has been created • Plan to integrate new Access to Recovery online referral system (drugs, alcohol) and smoking cessation program quit line with screening tool • Partnership with Louisiana’s Tobacco Control Program and Office of Behavioral Health

9. Data and Measurement • Increase DHH Data Capacity and Performance Measurement • of Maternity and Neonatal Care • Inclusion of preconception metrics into reporting requirement structure of new state wide managed care networks • Vital records revision to measure non-medically indicated elective deliveries < 39 weeks • Portal being built for hospital report cards • Nulliparous term singleton vertex cesarean delivery rates (NTSV) • 3rd and 4th degree Laceration rates • Gestational age rates stratified by level of NICU (regionalization) • GIFT breastfeeding certification (yes or no) • Internal then public release; hospital then provider reporting • Newborn screening amended to include breastfeeding initiation • Web based portal for behavioral health screen • Partnership with Hospital Association and Blue Cross