Catalyst for Payment Reform

California is changing the game on maternal care quality

California is changing the game on maternal care quality

California is leading the charge to defy the distressing maternal mortality trends nationwide. While nationally the rate of maternal deaths rates rose from 2006-2013, California achieved a 55 percent reduction. This Golden State success is owed to the California Maternal Quality Care Collaborative, founded in 2006. The CMQCC uses research, quality improvement toolkits, collaboratives and data to improve maternal health and outcomes for women and their babies across the state.

An important facet of CMQCC’s work is their maternal mortality review board, tasked with reviewing each mother’s death in detail and identifying the cause of death. Their reports seek to honor the memories of the women who died during or after their pregnancies by improving the experience of expectant mothers everywhere. Through their reviews, they’ve identified hemorrhage and preeclampsia as the two most common life-threatening complications, both of which can be prevented and managed to save lives.

To spread best practices in managing such complications, the CMQCC publishes free toolkits, downloadable from their website. The toolkits include detailed, evidence-based instructions for providers and hospitals to prepare for and manage the potential preventable complications common with childbirth. So far, CMQCC has toolkits for eliminating early elective deliveries, improving responses to preeclampsia and hemorrhages, reducing cesarean deliveries and others. A 2017 study in the American Journal of Obstetrics & Gynecology happily found a near 21 percent reduction in maternal morbidity for women with hemorrhage in hospitals using CMQCC’s programs, compared to the baseline.

CPR’s Executive Director, Suzanne Delbanco, chatted with Elliott Main, CMQCC’s Medical Director, who led the maternal mortality review board initiative, on CPR’s Listening In podcast.

CMQCC’s efforts have also resulted in increased accountability and quality care by encouraging healthy competition among providers. Take St. Joseph Health, St. Mary in Apple Valley, California, for example. St. Mary’s won a CMQCC award for lowering their C-section rate to 21 percent by following CMQCC’s approach and saw physicians and nurses at the hospital taking on greater responsibility and even pride for their part in improving early elective deliveries and reducing hemorrhage risk among other maternal health indicators. By holding doctors publicly accountable for their patients, displaying maternal deaths, early elective deliveries and statistics for other preventable condition, CMQCC is bringing providers into the conversation and incentivizing them to perform better when it comes to childbirth.

There’s another homegrown force that’s using the momentum from the CMQCC public-private partnership to really drive better outcomes for mothers in the Golden State: a coordinated effort between large purchasers of health care, including Covered California, CalPERS, PBGH and Medi-Cal.  As documented in a March 2019 report published by Covered California, the state’s health insurance marketplace and a CPR member, this group of innovative purchasers is requiring their contracted health plans to track the cesarean delivery rate performance of all hospitals in their networks. Not only must the health plans track hospital performance, but they must either exclude hospitals that have not achieved or made significant improvements toward the Healthy People 2020 target rate of 23.9% for low-risk pregnancies, or explain why they, as a health plan, must keep the hospital in their network. This sends a strong signal to hospitals to make improvements.

Building off of the solid foundation CMQCC provides, and spurred by progressive purchaser policies, California is paving the way to reversing the nation’s trends in providing quality health care for moms. Covered California found that the majority of hospitals have now achieved or exceeded the target rate while improvement continues, and that a whopping 4,450 C-sections were avoided in California in 2017. This directly translates into less risks for moms and babies, lower spending, and, finally, something to celebrate after years of stagnation.

Feeling inspired? Access CPR’s updated Action Brief on Maternity Care payment to dive deeper into the area.

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