Centering Pregnancy. Better Health Partnership Learning Collaborative April 13, 2018

Transcription

1 Centering Pregnancy Celina Cunanan, CNM, MSN UH System Chief for Nurse-Midwifery Alison Tomazic Centering & Midwifery Program Manager Better Health Partnership Learning Collaborative April 13, 2018

2 No financial or non-financial conflicts of interests relevant to this presentation.

3 Learning Objectives: 1. To understand the concept and components of the Centering Pregnancy model of care 2. To review the impact of Centering Pregnancy on infant mortality and quality metrics 3. To discuss the local efforts to expand Centering Pregnancy

4 Infant Mortality

5 Infant Mortality is considered the hallmark of the overall health of a city, state or nation # deaths after live birth prior to one year of life per 1000 live births Healthy People 2020 Infant Mortality Rate Goal: 6.0 per 1,000 live births

6 Infant Mortality: United States, 2010

7 Infant Mortality Data

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9 CCBH Preliminary Infant Mortality Data 2017 YEAR Total Births Total Deaths Black IMR White IMR Overall IMR Black-to- White Disparity Preterm Birth Rate 2016* 14, % , % *Official audited data from ODH for Cuyahoga County CCBH unaudited data as of March 12, final statistics by mid

10 March of Dimes 2017 Preterm Birth Report Card Cleveland 14.9% 9.8% 10.4% 12.1% Cuyahoga Ohio: Grade D Black women are 46% more likely to have a PTB vs white women Cuyahoga County: Grade F Cleveland has the worst rate of preterm birth out of 100 cities nationwide 10

11 What is Centering? Centering Pregnancy (CP) is an outcome-driven, cost-effective, patient-centered, innovative model of group care based on three components: 1. Health Assessment 2. Interactive Learning 3. Community Support

12 What is Centering?

13 Why Centering? Centering Pregnancy proven to: Triage visits Preterm birth rate (PTB) (<37 wks) Magnified for African-American women Low birth weight babies (LBW) (<2500g) Postpartum depression rates Breastfeeding rates Visit compliance Patient satisfaction Patient knowledge & readiness for birth

14 Other Advantages provider satisfaction patient revenue patient empowerment & ownership Builds community support Provides ongoing benefit to health across lifespan & to other disciplines (diabetes) Innovative models of care can help to address health care provider shortages CP is recommended by the Ohio Collaborative to Prevent Infant Mortality (OCPIM) & First Year Cleveland (FYC) as a key intervention to prevent preterm birth

15 Ickovics et al. (2007) Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and Gynecology, 110(2), part 1: To determine whether group prenatal care improves pregnancy outcomes, psychosocial function, & patient satisfaction; and to examine potential cost differences Multisite Randomized Controlled Trial Two University-affiliated hospital clinics (Yale, Emory) n=1047 (group=653 vs traditional=394) 80% African-American Mean age=20.4

16 Ickovics et al. (2007) Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and Gynecology, 110(2), part 1: Group care resulted in: 33% reduction in preterm birth (9.8% vs 13.8%) 41% reduction for AA women (10% vs 15.8%) Less likely to have inadequate prenatal care (26.6% vs 33%, p<.01) Better prenatal knowledge & readiness for labor & delivery (each p<.001) Greater satisfaction with care (p<.001) Increased breastfeeding initiation (66% vs 55%, p<.001) No added cost No difference in birth weight

17 How does Centering decrease PTB?

18 Maternal stress increases risk for PTB

19 Extreme Stress: Systemic Racism

20 Centering decreases maternal stress & builds community

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23 Centering Pregnancy: University Hospitals

24 UH Centering Pregnancy Birthed by the Midwifery Division in 2010 Over $600K in grant funding + $670K ODM Sites: UH Rainbow/MacDonald (new Center July 2018) UH Ahuja (evening) UH Portage UH St. John Medical Center Fall 2018 Group model care: Centering Pregnancy Centering Parenting w/family Medicine Diabetes Boot Camp Group Diabetic Care Menopause Group Education Mom Power 24

25 UH Centering Pregnancy Innovations Innovations: 25

26 UH Centering Pregnancy Baby Box launch Nov 2016

27 Quality Outcomes: University Hospitals YEAR PTS ENROLLED PRETERM BIRTH (PTB) LOW BIRTH WEIGHT (LBW) DISCHARGE C/S RATE TOTAL BIRTHS % 8% 70% % 5% 72% 17% % 13.6% 71% 14% % 14% 74% 16% % 7% 85% 16% % 9% 86% 13% % 5% 85% 26% % 4.3% 80% 22% 160 TOTALS % 8.24% 78% 18%

28 UH Centering Parenting

29 UH Centering Parenting May 2012-Dec 2017 Total enrollment=265 Program completion (thru 18 mos)= 197 Attendance Vaccine Compliance 2 mos 83% 100% 55% 4 mos 85% 100% 40% 6 mos 85% 100% 27% 12 mos 75% 96% 10% Breastfeeding Rate

30 UH Rainbow Center for Women & Children-July Centering rooms 2200 sq feet of group space Ability to run up to 6 groups/day

31 Lean Health Care Practitioner Certification: Centering Pregnancy Optimization Sept 2017 Tenisha Gaines Centering Program Director Project Lead Celina Cunanan, MSN, CNM UH System Chief for Nurse- Midwifery Ann Konkoly, MSN, CNM Medical Director, Women s Health Center Jessica Switzer Intern, Department of Operational Effectiveness 31

32 Recognize Define Measure Analyze Improve Control Realize Lean Certification: CP Value Stream Mapping Current Future 32

33 CP Billing Opportunities Bill for correct level of service Level 5 E/M for 10 visits Current Medicaid Reimbursement S/H modifier codes (6 code types) o Additional billed = $396/patient o Additional paid = $130/patient Goal: Enroll 500 patients in 2018 Additional billings = $198,000 Additional payments = $ 65,000 Opportunities Revenue Current state 6 patients/session $ Future state 8 patients/session $ Future state 8 patients/session with optimized billing $ Future state 8 patients/session with optimized billing annually $ 83, Copyright by KAVON International, Inc. & JMP Consulting, All Rights Reserved.

34 UH future Centering models OB Residency Continuity Clinic 2018 Mom Power incorporation 2018 Centering Parenting expansion 2018 Expansion to High Risk OB Populations Group diabetic care Obesity Preterm Birth Fetal Care Center patients Family Planning Family Medicine (FNP) HTN, Diabetes, Obesity UH Community Hospitals: SJMC, Elyria, Geauga, Parma, Portage

35 UH Named CHI Regional Leadership Partner in Midwest 35

36 FIRST YEAR CLEVELAND Centering Coalition

37 FYC SOLUTION: CREATE A DATA-INFORMED COMMUNITY COLLABORATIVE Organizational Description 13-Cuyahoga County civic leaders established First Year Cleveland in December 2015 FYC Advisory Council includes over 300 community representatives from more than 70 organizations FYC is a collaborative, grassroots effort with a bottom-up approach FYC draws on the experience and wisdom of our community Parents and grandparents Neighbors Frontline caregivers Leaders from health systems, civic groups, volunteer organizations, and faith-based community 37

38 FYC SOLUTION: CREATE A DATA-INFORMED COMMUNITY COLLABORATIVE Structure Case Western Reserve University School of Medicine serves as First Year Cleveland's fiscal agentand provides in-kind support for executive staff leadership and operations, including space funders include: Ohio Department of Medicaid Ohio Department of Health including Cleveland-Cuyahoga County Ohio Equity Institute Cuyahoga County, County Executive Armond Budish and Cuyahoga County Council City of Cleveland, Cleveland Mayor Frank G. Jackson and Cleveland City Council 38

39 FYC STRATEGIC PLAN: VISION + MISSION Our Vision Every baby born in Cuyahoga County will celebrate a first birthday Our Mission Tomobilize the community through partnerships and a unified strategy to reduce infant deaths including racial disparities 39

40 FYC STRATEGIC PLAN: 3 PRIORITIES THROUGH Reduce Racial Disparities 2. Address Extreme Prematurity 3. Eliminate Preventable Sleep-related Infant Deaths 40

41 FYC MOBILIZATION STRATEGY

42 FYC Centering Coalition-est Nov 2016 Co-Chairs: Alison Tomazic (NFP) & Celina Cunanan, CNM, MSN (UH) Purpose: Support network for CP coordinators and providers in Cuyahoga County Share best practices, discuss challenges, brainstorm ideas Provide local CHI facilitation training for Coalition members Present a unified message about Centering across the county Centering newsletter for service agencies and providers MomsFirst, WIC, Bright Beginnings, etc. County wide data collection with Cuyahoga County Board of Health

43 FYC Centering Coalition Members FQHCs: Neighborhood Family Practice (NFP) Northeast Ohio Neighborhood Health Services (NEON) Care Alliance Partners: FYC Executive Director Ohio Equity Institute Cuyahoga County Board of Health Hospitals: University Hospitals Cleveland Clinic Metro Health

44 FYC ODM Funding: Rounds 1 & 2 (1/1/17-12/31/18) $1.5 M over 2 yrto fund Centering expansion to FQHCs: NFP Expansion to Puritas-June 2017 Care Alliance Initiation in Central Neighborhood- June 2017 NEON Restarted at Hough site-may 2017

45 FYC ODM Funding: Round 3 (1/1/18-6/30/19) $1.4 M for Centering Pregnancy in Cuyahoga County UH, CCF, Metro NFP Enrollment goals: Q4 2018: Q4 2019:

46 2017 Preliminary Coalition Outcomes All 6 programs reporting: Preterm Birth Rate=4.9% Low Birth Weight=4.5% Breastfeeding at Discharge Rate=69.3% African-American=77%

47 CALL FOR ACTION Talk to clients about their risks Talk to clients about the benefits of Centering Refer clients to any of the 6 Centering Coalition sites Support efforts to expand Centering programs in your areas Support higher reimbursement for Medicaid and commercial insurances for Centering

48 Thank You! 48