Data Identifies Opportunities for Better Maternal Healthcare

Two of the most crucial doctor appointments during pregnancy take place in early pregnancy and again shortly after baby is born. These are the points in time when an obstetrician (OB) or midwife can identify pregnancy concerns and/or obstacles to postpartum care.  When data from these important care episodes are combined with data around birth outcomes and whole health needs, an obstetrical care provider can implement changes that may improve pregnancy, birth, and postpartum outcomes.

“Having access to high-quality, real-time data makes it easier for maternal practices to improve their processes and deliver the best evidence-based care,” said Dr. Tiffany Inglis, Carelon national medical director for maternal-child and women’s health. “Such actionable information closes gaps in care, builds trust, and results in more healthy births.”

This insight led Elevance Health to create the obstetrics practice consultant (OBPC) role. Clinicians with maternal care expertise who work closely with obstetrical practices and their staff, OBPCs have proven to be an essential part of delivering high-quality care. Practice consultants provide data that supports care providers, which in turn helps care providers deliver evidence-based care and improve patient experience. Some physician practices also choose to participate in one of many value-based care arrangements that Elevance Health offers, such as the OB Quality Incentive Program (OBQIP). Together, these programs help support women to feel valued and heard throughout their maternity care experience. Elevance Health-affiliated health plans insure one out of every eight births in the United States, and we believe collaboration and connection with care providers is essential to creating meaningful engagement and improving birth outcomes.

The OBQIP program distributes financial incentives to care providers who achieve high-quality performance. Care providers who worked with an OBPC and participated in the OBQIP from 2020-2022 saw, on average

• 20% reduction in low birth weight.
• 12% reduction in preterm birth rates
• 5% reduction in total birth costs.
• 67% increase in postpartum visit adherence.

“These numbers show higher quality outcomes and more healthy, full-term births without complications,” Inglis said.

Representatives from OB practices in Kentucky, Virginia, and New York described their experiences with the program. Comments have been edited for length and clarity.
 

What prompted you to join the OB quality incentive program?

Heather Bennett, director of quality assurance for Cumberland Family Medical Center, Kentucky:  We thought this program would help us to not only confirm the good quality of care we provide but would give us the tools to know exactly what targets to meet.

Melissa Hitchcock, assistant practice administrator for Dominion Women’s Health, Virginia: [Following] a quick overview of the program [in 2018]… we [learned we] were going to have metrics provided to us surrounding our OB patients, and the incentive payment would coincide with meeting those metrics. It seemed like an easy decision to make, and we enrolled by the next business day.

Jennifer Piscitelli, regional healthcare transformation manager for Unified Women’s Healthcare, New York:  We are always striving to make improvements for the best patient outcomes and joining various quality programs is one way we accomplish that.
 

What changes have you made to your practice as part of the program?

Bennett:  We meet with our OBQIP representative monthly to monitor the status of any gaps in quality of care.  This allows us to better gauge our patients who have and have not completed their postpartum visits as well as those who have an updated cervical cancer screening.  For those who may have cancelled or did not show up for their postpartum visits, we contact them to try to get them in.  

Hitchcock: Since enrolling in the program, we have made gradual changes to improve outcomes. It started with changes to coding but has evolved to changes with documentation, scheduling, and staff education, with the goal of improving patient care.
 

Why do you think this program is helpful for improving outcomes in maternal health?

Bennett: Early prenatal care decreases risks during pregnancy and increases the chance of a safe delivery. There are many screening tests that are done during pregnancy to detect disease processes. This early detection allows us to treat diseases that otherwise, if left untreated, could be detrimental to maternal/infant lives. Making sure our patients attend their postpartum visits addresses any issues that may have arisen since the birth of the baby. Issues such as persistent bleeding, blood pressure irregularities, pain, emotional changes, and infections can be addressed. 

Piscitelli:  Reviewing the metrics and implementing change in the area of pre-term birth metrics, making improvements in primary c-sections, and postpartum follow up results in better patient outcomes and long-term health improvements.

Hitchcock: Having the same practice consultant that has consistently been with us has made a difference in this. She has the knowledge and experience as a nurse to know realistically how to help guide us to achieving better outcomes.
 

What have your practice results been so far?

Bennett: We have been exceeding targets for timeliness of prenatal care, preterm birth rates, low birth weight rates, and primary c-section rates.

Hitchcock: We have made significant improvements in timeliness of prenatal care as well as postpartum visits.

Piscitelli: Our Q2 and Q3 results have been greatly improved, and we are looking forward to seeing the last quarter results for 2022.
 

How would you describe your practice consultant?

Bennett: Our program representative is the BEST! We speak with [her] in live meetings at least monthly and phone calls in between meetings.  She is great at helping guide us to exceed our goals. We are thankful to have her!

Hitchcock: She has been helpful because of her experience in a clinical setting in knowing the reality of what we do. She is able to take the expectations of the health plan (and) accurately communicate this information to us as a provider.

Piscitelli:  Our practice consultant is integral to our success by meeting and discussing results and mitigating issues. She makes the review of scorecards clear and helps determine next steps.