How to Integrate Midwives to Improve Outcomes

Transcription

1 How to Integrate Midwives to Improve Outcomes 2018 Midwifery Works October 12, 2018 SIMPLE POWER POINT PRESENTATION

2 Tools to download at

3 Agenda Introduction and Background Methodology of Tool Design Key Learnings and Discussion Tool Overview Real World Scenario Discussion Next Steps Q+A 3

4 Pacific Business Group on Health *Silicon Valley Employers Forum represents an additional 43 high-tech employers

5 Maternal Health in the U.S. Poor outcomes Unnecessary care High spend 5

6 PBGH s Transform Maternity Care Priorities Reduce C-sections nationally to global standards Expand use of CNMs and birth centers Reduce NICU utilization Spread bundled payment in maternity care Develop Maternity Patient Reported Outcome Measures 6

7 Given the benefits of midwifery, why do CNMs only deliver 9% of babies in California? How to Successfully Integrate Midwives into Your Practice 7

8 Overview of Barriers Analysis Policy Organizational Interpersonal Personal Legislation/regulatory Hospital Payer Liability insurers Obstetricians Consumers How to Successfully Integrate Midwives into Your Practice 8

9 Vision To change the prevailing medical culture around maternity care and create an environment where all women can choose a midwifery model of care. 9

10 TMC s Midwifery Blueprint for Action Strategy 1: Make the Business Case Strategy 2: Scale Best Practices in Collaborative Care Strategy 3: Promote Uptake of Payer Best Practices Strategy 4: Harness Consumer Demand Strategy 5: Expand Birth Centers 10

11 Building the Foundation for Transformation Barriers Analysis for Midwifery Access in California Midwifery Blueprint for Action Criteria for High- Functioning Practices Business Planning White Paper + Pro Forma Tool Midwifery Integration Guide with Appendices Materials available at 11

12 Tool Development 12

13 Study real working models to Objective 1 Demonstrate $$ value CNMs offer maternity care practices/hospitals Objective 2 Identify and share best practices in midwifephysician collaboration 13

14 Methodology Complete literature review Develop best practice criteria Recruit practices representing an mixed sizes, ownership structures, and payer mixes Conduct in-depth interviews with clinicians and business leads Analyze and synthesize collected data, literature, and consultant expertise 14 How to Successfully Integrate Midwives into Your Practice

15 Selected Sites for Interviews Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Setting HMO Based Physician Owned Physician Owned Physician Owned Physician Owned Midwifery Owned Hospital/ Community Based Caseload Shared Shared Separate Shared Separate Separate Separate Call Shared Separate Separate Shared Separate Separate Payer Mix Mixed Commercial Mixed Commercial Mixed Commercial Medicaid Geography Mixed Rural Rural Suburban Suburban Urban Urban Size (annual births) Large Small 720 Births Medium 875 births Small 540 births Large 2500 births Large 1097 births Large 2160 births 15 How to Successfully Integrate Midwives into Your Practice

16 Tools to download at

17 Key Learnings 17

18 Learning While midwifery can thrive in a variety of practice models and settings, organizations are generally not strategic in their design of the model. 18

19 Started with Strategic Planning 19

20 Defined critical elements of practice design 20

21 Learning Demand exists for resources on how to establish new midwifery practices AND strengthen existing midwifery practices. 21

22 Designed Guide to Meet Diverse User Needs 22

23 Learning The value of midwifery often transcends dollars and cents. 23

24 Other Key Value Factors Quality Access Patient satisfaction Clinician burn-out Market growth 24 How to Successfully Integrate Midwives into Your Practice

25 Strategic Steps to Develop a Business Plan On page 14 of the Guide 25

26 Tools Overview 27

27 Financial Tools 1. A white paper describing key financial considerations to develop a business plan for CNM Integration 2. A pro forma tool to help hospitals and provider groups estimate the costs and revenues of hiring a midwife Funded by the California Health Care Foundation and the Transforming Birth Fund How to Successfully Integrate Midwives into Your Practice 28

28 Intended Audience CFO of medical group OBGYN Financial lead of Maternity Business Unit at an acute care hospital CFO of health plan considering increasing adoption of CNMs CFO of FQHC with maternity within their scope of services 29 How to Successfully Integrate Midwives into Your Practice

29 Business Planning White Paper 1. Assess Current and Evolving Landscape 2. Consider Resource Allocation 3. Develop a Pro Forma 4. Develop a business plan 30 How to Successfully Integrate Midwives into Your Practice

30 Other Learnings Practice viability depends greatly on model and setting Efficient allocation of midwives can free up physician resources to see higher acuity patients It is difficult to achieve sustainability when delivering mostly Medi-Cal patients How to Successfully Integrate Midwives into Your Practice 31

31 Pro Forma Projection Tool Estimates the financial value of adding a CNM into maternity care practice based on practice type and practice-specific characteristics 32 How to Successfully Integrate Midwives into Your Practice

32 Tool Inputs Tab 1 Setting Selection Tab 2 CNM Workload Tab 3 CNM Revenue Mix Tab 4 CNM Revenue Unit Price Tab 5 Other Revenue Tab 6 CNM Expense Tab 7 Other Expenses 33 How to Successfully Integrate Midwives into Your Practice

33 Tool Outputs Expected patient panel associated with adding 1 full time equivalent (FTE) CNM; Revenues generated by adding 1 FTE CNM; Expenses incurred by adding 1 FTE CNM; Profit 1 FTE CNM could generate. 34 How to Successfully Integrate Midwives into Your Practice

34 Midwifery Integration Guide Funded by the Yellow Chair Foundation How to Successfully Integrate Midwives into Your Practice 35

35 Midwifery Integration Guide Part 1: Secure Support Part 2: Establish the Practice Part 3: Create a High- Performance Practice Part 4: Create a Plan to Monitor Success 36 How to Successfully Integrate Midwives into Your Practice

36 Midwifery Integration Guide Step 1: Gather Info Part 1: Secure Support Step 2: Engage Stakeholders Step 3: Make a Business Plan Step 4: Assemble Key Stakeholders Step 5: Develop Strategic Plan 37 How to Successfully Integrate Midwives into Your Practice

37 Midwifery Integration Guide Step 1: Define Roles Step 2: Build the Model Part 2: Establish the Practice Step 3: Build the Brand and Communication Materials Step 4: Select and Hire Step 5: Prepare to Onboard Step 6: Orientation 38 How to Successfully Integrate Midwives into Your Practice

38 Midwifery Integration Guide Part 3: Create a High- Performance Practice Step 1: Cultivate Collaboration Step 2: Recruit Champions Step 3: Invest in engagement and retention Step 4: Nurture the Team 39 How to Successfully Integrate Midwives into Your Practice

39 Midwifery Integration Guide Step 1: Ensure Financial Success Part 4: Create a Plan to Monitor Success Step 2: Monitor Outcomes Step 3: Integrate Learners Step 4: Recognize and Celebrate Success 40 How to Successfully Integrate Midwives into Your Practice

40 Discussion 41

41 Discussion How do you think you will apply these tools in the real world? 42

42 Discussion Scenario: A CNM has recently moved to a rural part of California where childbirth providers are in short supply (with very few midwives in practice) and outcomes are among the worst in the state. The local hospitals do not perceive a need or a demand for midwifery. How would you use these tools and resources to approach this issue? 43

43 Discussion What ideas do you have about using these tools in your existing midwifery practice: Develop or modify your strategic plan Revisit the collaborative relationships between midwives and physicians Re-engage key stakeholders who can provide support for the practice to grow 44

44 What s Next 45

45 TMC s Midwifery Blueprint for Action Strategy 1: Make the Business Case Strategy 2: Scale Best Practices in Collaborative Care Strategy 3: Promote Uptake of Payer Best Practices Strategy 4: Harness Consumer Demand Strategy 5: Expand Birth Centers 46

46 Disseminate the Guide B A Grand Rounds Series Recruiting for sites and midwife-physician speakers this fall! 47

47 Promote Payer Best Practices Assess health plan practices Create menu of purchaser and payer best practice options Promote uptake 48

48 Accelerate Employer Influence Launch maternity centers of excellence Can we establish direct contacts between employers and high performing facilities with midwives? 49

49 Criteria to Identify Best Practice Sites Essential Criteria 1. Maternity unit or practice is financially sustainable 2. Practice collects baseline quality metrics 3. Midwives employed for at least 2 years 4. Midwives attend at least 20% of births OR 24/7 CNM coverage OR a 1:3 CNM/Physician staffing ratio 5. Midwives practice at top of license 50

50 Questions Feedback 51