Transcript OB Report and Implementation Plan Presentation

OB Report & Implementation
Plan
Bree Collaborative Meeting
August 2, 2012
2
Outline of Presentation & Actions
Needed from the Bree Collaborative
• To present and discuss new edits in OB report
• To discuss Patient Decisions Aids – a new proposed
addition (not yet incorporated in report)
• To discuss and get Bree Collaborative members’
feedback on OB implementation plan
• 2 Proposed Action Items:
▫ Adopt OB report (with or without changes)
▫ Adopt implementation plan
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Finalizing OB Report - RECAP
• The Bree Collaborative at its May 31st meeting approved
OB report with small changes to employer/payer
recommendations; gave authority to steering committee
to finalize the report
• OB subgroup on June 19th were asked to endorse final
report (because some subgroup members could not join
the May 31st meeting due to phone issues)
▫ Subgroup members’ small editorial edits incorporated into report
• Steering Committee approved final report on July 3rd
• Additional edits were proposed and asked to be
considered on July 6th
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New Edits
• Remove words “Hard Stop” in hospital and
employer/purchaser recommendations
▫ Nomenclature change; content/intent did not change
▫ Words “hard stop” still used in OB Effective Programs
section (pg 6) & Franciscan Case Study
• Elevate “consultation” requirement from footnote to
body prose
• Revise Labor and Delivery Guidelines for C-Sections
▫ Precision added
▫ Verbs more affirmative in tone
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Edit #1: Hospital Recommendation
(pgs 10 & 11)
•Old: A type of Hard Stop Policy for Scheduling Elective
Inductions/Deliveries/C-sections (using The Joint
Commission and State of WA lists)
•New: “Guidelines for Scheduling Deliveries before the
39th week: Hospitals should implement a policy for
scheduling deliveries before the 39th week that includes
the following two components:
 The indication must be on The Joint Commission or the
Washington State list used in the current elective delivery
between 37 the 39 weeks Washington State Perinatal
Collaborative/WSHA project; and
 For clinical situations not on the two lists listed in number one
above, consultation must occur and agreement must be
obtained that the clinical situation requires delivery.
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Edit #1 con’t: Employer/Purchaser
Recommendation Edit (pg 13)
•Old: Require hospitals and physicians to implement a
“hard stop” scheduling policy on elective deliveries or Csections prior to 39 weeks or require pre-authorization;
(pre authorization process should reduce burden on
practice when performance is demonstrated)
•New: Require hospitals and physicians to collaboratively
implement scheduling policies on elective deliveries before
39 weeks and elective inductions of labor between 39 and
up to 41 weeks in accordance with guidelines proposed for
each procedure at the bottom of page 11/ top of page 12, or
require consultation for acceptance of exceptions
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Edit #3: First two bullets of Labor and Delivery
Guidelines for C-Sections (pg 11)
Old
• Restrict admission for spontaneously laboring patients
to those whose cervix is dilated to 4 centimeters or more;
• Avoid C-section for first stage arrest in the latent phase;
New
• Admit only those spontaneously laboring women at term
who present with no fetal or maternal compromise when
the cervix is 4 centimeters or more dilated.
• Allow first stage labor arrest cesarean (reassuring fetal
and maternal status but lack of progress of labor) to be
performed only in the active phase (equal to or more
than 6 centimeters dilation).
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Patient Decision Aids
• Proposed strategy to be added to “WA HCA and WA DOH
Recommendations” (pg 12)
Assist practitioners and facilities with the provision of easily accessible, statecertified Patient Decision Aids (PDA’s) which will provide unbiased
balanced information and a consent format for patients regarding risks and
benefits of procedures or treatments, such as elective induction less than 39
wks, primary C/section by maternal choice, etc. PDA's protect both the
patient and the practitioner/facility by the clarity of the information
provided. If there is a legal action based on lack of informed consent, a
PDA provides "prima facie evidence (evidence that will prevail unless
rebutted by clear and convincing evidence) of informed consent that the
patient or his or her representative signed an acknowledgement of shared
decision making.“
• [Existing RCW 7.70.060 now specifies that certification is the responsibility
of the Medical Director of WA State Medicaid if there are no national or
international organizations which have certified PDA's].
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Submission to HCA
• Per Bree legislation Bree must send report with cover
letter to HCA administrator with chosen topics &
proposed strategies (not just OB)
(Target date: August 6th)
▫ HCA administrator must review the strategies and
recommendations and make a decision whether to adopt and
apply recommended strategies to state purchased health care
programs.
• Following the administrator’s review, the Bree
Collaborative must report to the legislature and the
governor regarding proposed strategies and the results
of the administrator’s review
(Proposed target date: August 30th)
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OB Implementation Plan
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OB Implementation Facts & Ideas
• Nothing in Bree legislation about Bree’s role in
implementation of recommendations
• Little funding for implementation activities
Given the facts…
• Bree Collaborative Steering Committee gave feedback on
earlier draft plan during July 3rd conference call
• Leverage existing efforts and networks & work with
partners to maximize reach
• Everyone has a role to play to promote report and its
recommendations
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Governor Gregoire
State agencies – Dept of Health; WA Medicaid; Health Care Authority; PEBB; and Dept of
Social and Health Services
Partners – March of Dimes, WSHA, WSMA, WA Obstetrical Association, and PS Health
Alliance
Bree Collaborative Members
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Proposed State Agencies’ Roles (vs. Bree)
Agency/Group
Main Proposed Roles
Bree Staff
• Lead on sending and promoting Bree report to
all interested parties and stakeholders: hospitals,
employers/purchasers, health plans, individual
providers and patients
• Lead on health plan recommendations
• Lead on reaching out and educating
employers/purchasers
WA Dept of Health
(through the WS Perinatal
Collaborative (WSPC)
• Lead on providing TA to hospitals and
individual providers, with help from the Bree
Collaborative
WA Health Care
Authority/Medicaid/
PEBB
• Lead on applying all recommendations to state
health care purchased programs
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Main Implementation Activities
conducted by Bree Staff, by Stakeholder
• All Stakeholders & Partners, local and national
▫ Send copy of the report
• Employers and Purchasers
▫ Present to employers and employer groups
▫ Provide announcement in in-house newsletters
• Hospitals
▫ Send letter and report to all WA hospitals with
obstetric departments (letter addressed to CEO,
OB Chief, & medical staff president)
▫ Present to hospital boards
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Main Implementation Activities conducted
by Bree Staff, by Stakeholder, Con’t
• Health Plans
▫ Convene meeting with all WA health plans to
discuss quality initiative & bundled payment
reform ideas
• Individual Providers
▫ Collaborate with key obstetric partners (WA
Perinatal Collaborative, ACOG-WA, WA State
Obstetrical Association, WSMA)
• Media
▫ Pitch report to health reporters throughout WA
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Timeline at a Glance
Activity
Presented OB report at Puget Sound Health Alliance
Purchaser meeting
Bree Collabortive meeting – finalize and endorse
implementation plan
Send OB report to HCA administrator
Send OB report to stakeholders
Presentations to employers and employer groups
Target Date
July 18, 2012
Publicize report in partner newsletters
August/September 2012
Letter to hospitals
Send OB report to Governor and legislature
Pitch to media
Convene plans re quality incentive & payment reform
August 30, 2012
August 30, 2012
August 30, 2012
September 15, 2012
Presentations to hospitals boards
September/October
2012
August 2, 2012
August 6, 2012
August 15, 2012
August/September 2012
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Proposed Partners
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Bree members
All WA health plans
WA Hospitals
WSHA & WSMA
March of Dimes
WA State Perinatal Collaborative
ACOG-WA, WA State Obstetrical Association
Legislators
Employer groups (through the Puget Sound Health Alliance,
WA Roundtable, WAB, Seattle Chamber)
• Employers (King County, REI, Boeing, etc)
• National groups: Leapfrog, Consumers Union, Childbirth
Connection, Catalyst for Payment Reform, OB experts
• Insurance Commissioner
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Next Steps
• Create an OB Implementation Plan Advisory
Group (to help guide implementation efforts)
▫ Report to the Bree Collaborative (updates at Bree
meetings)
▫ Members of the OB Subgroup/representatives from
different stakeholder groups
▫ Proposed: Theresa Helle, Ellen Kauffman, MD, and
Mary Kay O’Neill, MD
• Collaborate with State Agencies on
implementation