The Value of the Maternity Care Learning Network: Better Health, Better Care, Better Costs by Linda Davis
The Action Group has focused on overuse through many of its initiatives over the last year. It is collaborating with ICSI on the Choosing Wisely® campaign in MN and completed a Learning Network initiative, open to all Action Group members, on back pain and surgery in June of 2013.
In July we moved on to maternity and infertility. As the Learning Network on this project completes the “Purchaser Guide on Maternity Care,” I have been reflecting on how our work over last the six months will have a long-lasting, positive impact on the health of babies and mothers.
At first, some people thought it strange that we included maternity as a focus of overuse. We explained it’s not pregnancy that’s overused, it’s certain related interventions. Selecting this topic put us in good company; the Choosing Wisely campaign also includes two maternity-related interventions with the potential for overuse (see inset).
- Don’t schedule elective, non-medically indicated inductions of labor or C-sections before 39 weeks.
- Avoid elective, non-medically indicated inductions of labor before 41 weeks, unless the cervix is deemed favorable.
Choosing Wisely also offers helpful maternity materials such as “What to reject when you’re
expecting” that advocate for conversations between physicians and patients by helping patients choose care that is:
- Supported by evidence
- Not duplicative of other tests or procedures
- Free from harm
- Truly necessary
As a part of this Learning Network, we held a Community Dialogue on maternity care last summer. Employer participants met to learn from our research, and from each other, about what’s right and wrong with maternity care today. We developed a Purchaser Value Statement and heard from health plans and Minnesota’s Medicaid Agency (which covers 40% of Minnesota’s births) about their efforts to improve safety, quality and reduce costs. We then met with five leading, metro-area maternity care providers to share the Value Statement and hear what they are doing to improve value for purchasers.
The new Purchaser Guide will discuss how to:
- Turn early elective inductions into “never events”
- Reduce C-section rates to World Health Organization recommended levels
- Increase quality and cost transparency for patients through public reporting
- Empower expectant parents with information on delivery options through engaging and empowering tools and services
- Explore the impact of various payment models on overused interventions
- Broaden the use of doulas, when desired, which is proven to reduce the risk of unnecessary medical interventions*
We will share our findings on the maternity project at a member meeting on February 4, 2014.
I would also like to encourage you to attend a Community Dialogue about our next Topic: Overuse in total hip and knee joint replacements. This event, originally scheduled for January 24, has been postponed due to a scheduling conflict. Look for an invitation with the new date soon. Employer participation is an essential part of the Learning Network, so if you want to become a part of it, please contact Kris Soegaard.
*Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula care, birth outcomes and costs among Medicaid beneficiaries. American Journal of Public Health, 2013;103(4): e113-e121.