FAQ.PNG

PARTICIPATING IN THE OBSTETRICS INITIATIVE

What is the Obstetrics Initiative or OBI?

The Obstetric Initiative (OBI) is an interdisciplinary quality initiative led by healthcare providers dedicated to improving women’s health. OBI seeks to engage maternity care providers and hospitals in a collaborative effort to reduce the use of primary cesarean delivery and to improve health outcomes for Michigan women and infants. OBI is a quality improvement project within the Michigan Value Collaborative (MVC).  MVC is sponsored by Blue Cross Blue Shield of Michigan (BCBSM) and aims to achieve the best possible patient outcomes at the lowest reasonable cost in Michigan hospitals.

What is an Obstetrics Initiative (OBI) Hospital?

An OBI Hospital:                                                                                                                                                                                       1. provides maternity care in Michigan                                                                                                                                                       2. is committed to supporting efforts to safely reduce cesarean deliveries for “low-risk” pregnancies                                                           3. has a designated Obstetric Champion(s). OB Champions are maternity care providers (MD, DO, CNM or CM, and RNs) that are directly involved in labor and delivery patient care and ideally quality improvement (QI). These individual(s) will represent individual hospitals, lead a hospital’s OBI participation, and serve as the leader of a team that will work to implement QI efforts.

As a maternity hospital, is participation in the Obstetrics Initiative (OBI) voluntary?

Yes, the decision to participate in the Obstetrics Initiative is voluntary. There are criteria regarding attendance of webinars and biannual meetings for participating hospitals. 

 What does the Obstetrics Initiative (OBI) provide to participating maternity hospitals?

The Obstetrics Initiative:

  • Facilitates a statewide community of maternity hospitals and maternity clinicians
  • Promotes consistent and standardized approaches to obstetrical care
  • Supports evidence-based labor and delivery practices
  • Provides educational webinars
  • Promotes evidence-based resources and tools
  • Presents data-driven insights into areas for focused quality improvement
  • Provide the opportunity to share experiences, outcomes (challenges AND successes), and best practices so that all can learn
  • Supports hospitals to develop their own site-specific goals with regards to obstetric care, specifically around supporting vaginal births and safely reducing cesarean births

 Why should my hospital participate in the Obstetrics Initiative (OBI)?

OBI fosters a network of Michigan maternity hospitals with a shared commitment to improving outcomes for moms and babies.  OBI provides hospitals and providers a platform for sharing best practices, specifically through targeted connections. OBI will disseminate best practices through educational webinars, site or regional visits, peer-to-peer learning, and mentorship. Additionally, OBI provides your hospital with actionable data on both quality and cost to enable you to improve your labor and delivery practices through obstetric reports. The Resources page of our website serves as a centralized resource for published and OBI hospitals’ materials, resources and tool kits that have enabled others to succeed.

What does participation in the Obstetrics Initiative (OBI) involve?

  • Commit to improving birth practices and outcomes for moms and babies by supporting efforts to safely reduce cesarean deliveries for “low-risk” pregnancies
  • Share best practices, challenges, and engage in the peer-to-peer activities with OBI Hospitals
  • Attend OBI educational webinars
  • Utilize the Obstetric Reports to bench mark and quality improvement and provide feedback on the utility of the reports
  • Attend Semiannual MVC OBI Meeting(s) in April and November
  • Identify a new practice to implement in 2019
  • Complete Obstetrics Initiative surveys (up to 3 in a year)

Is there is a cost associated with participating in the Obstetrics Initiative (OBI)?

No, there is no cost associated with participating in OBI.

Does participation in the Obstetrics Initiative (OBI) require collecting and submitting data?

OBI currently asks participating hospitals to submit survey information two to three times per year.  OBI does not have a chart review protocol and does not ask hospitals to collect and submit data.  The utilization and outcomes reports are based on analyses of administrative claims data from Blue Cross Blue Shield of Michigan and Birth Certificate data from the Michigan Department of Health and Human Services Vital Statistics.

Which individual(s) should represent my hospital in the Obstetrics Initiative (OBI)?

Physicians, midwives, nurses, unit leadership, and quality improvement experts, and patients are eligible to represent your hospital.

What is required of the OB Champions in the Obstetrics Initiative (OBI)?

OB Champions will represent individual hospitals, lead a hospital’s OBI participation, and serve as the leader of a team that will work to implement QI efforts.

What happens at the semi-annual Michigan Value Collaborative (MVC) Obstetrics Initiative (OBI) meetings?

OBI hospitals are asked to send their OBI Champion(s) or their designee to attend our two semi-annual MVC OBI meetings in April and November. At the meeting, we review new performance data, present collaborative strategies for improving quality as well as network with other OBI hospitals.

What is the relationship between the Obstetrics Initiative (OBI) and the Michigan Alliance for Innovation on Maternal Health (MiAIM)?

OBI is working with the Michigan Alliance for Innovation on Maternal Health (MiAIM) to coordinate statewide efforts to improve maternal and neonatal outcomes. OBI is also a regular participant of MiAIM’s Outreach & Implementation Workgroup.

The national AIM program has developed 11 obstetric safety bundles. Mi AIM has been working diligently since 2016 to promote implementation of two patient safety bundles—the obstetric hemorrhage and severe hypertension  in pregnancy. OBI is now working to promote the Patient Safety Bundle regarding Safe Reduction of Primary Cesarean Births.

Does participation in the Obstetrics Initiative (OBI) require Institutional Review Board (IRB) approval?

No, the Obstetrics Initiative is a quality improvement initiative, not a research program. Moreover, all analyses and reports will be based on de-identified claims data and birth certificate data in aggregate.

How do I know if my hospital is participating in the Obstetrics Initiative (OBI)?

A list of engaged Michigan maternity hospitals is updated regularly on the OBI Hospitals page. Please contact OBI Project Manager, Nina Bobowski (npbo@med.umich.edu) if you would like to join OBI.

How can my hospital find current information on the Obstetrics Initiative (OBI) webinars, new reports, meetings, and events?

Maternity hospitals can stay up to date with OBI by subscribing with their contact information on our website, https://www.obstetricsinitiative.org/.

 

OBSTETRIC REPORTS

What data does the Obstetrics Initiative (OBI) use for their Obstetric Reports?

The Obstetrics Initiative collates data from Blue Cross Blue Shield of Michigan PPO claims, which provides data for 66 Michigan maternity hospitals. We are pursuing data use agreements to use birth certificate data from the Michigan Department of Health and Human Services Vital Statistics (MDHHS) and the Michigan Hospital Association Discharge data.  This will provide data on births covered by all payers (including Medicaid) from all 82 Michigan maternity hospitals.

How can I access my hospital’s reports?

Click here to log into the registry to view your hospital’s obstetric reports. If this is your first time, click “request access” on the page.  The Michigan Value Collaborative (MVC) will reach out to your MVC hospital Site Coordinator to grant permission.

The Obstetrics Initiative (OBI) is focused on pregnancies at low risk for cesarean delivery. How does OBI define “low-risk”?

OBI is working to promote vaginal delivery among women at “low risk” for a cesarean delivery. Low-risk women are those who present at term, with a singleton pregnancy in the vertex presentation (not breech).

OBI’s Obstetric Reports differentiate between delivery rates for “low” and “non-low” risk groups. What does this mean?

OBI is using the definition developed by the Society for Maternal-Fetal Medicine (SMFM) to stratify women with singleton pregnancies into groups who are “low” and “non-low” risk for cesarean delivery.  This definition takes advantage of diagnosis codes in administrative data to classify patients as “non-low” risk when there is a potential contraindication to a trial of labor (e.g. history of cesarean delivery, placenta previa, HIV, fetal malformations, HELLP).  (Low-Risk for Claims Data: Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. Armstrong, Joanne C. et al. American Journal of Obstetrics & Gynecology, February 2016, 214:2, Pages 153–163.) 

what Cesarean Delivery rates does obi use to monitor performance?

Nulliparous Term Singleton Vertex (NTSV) Cesarean Delivery Rate: Using birth certificate data from the Michigan Department of Health & Human Services, the NTSV Cesarean Delivery rate is the percentage of nulliparous women who have a Cesarean Delivery and who are term (>=37 weeks gestation) with a singleton, vertex gestation. 

Society for Maternal Fetal Medicine (SMFM) Cesarean Delivery Rate: Using claims data for the Preferred Provider Organization (PPO) patients in Blue Cross Blue Shield (BCBS), the SMFM Cesarean Delivery rate is the percentage of women who have a Cesarean Delivery and who are term (>=37 weeks) with a singleton, vertex, live born gestation and without a relative or absolute contraindications to vaginal delivery.

Will hospital performance data be kept confidential?

A hospital is able to view its own performance data against peers and statewide averages.  Hospital-specific performance data is not accessible by other hospitals.  Data on outcomes, utilization and payments derived from BCBSM-paid claims is available to BCBSM.

What are the expectations of OBI hospitals with regards to using the Obstetric Reports?

OBI developed these reports so that hospitals could use these data to identify target improvement opportunities, identify and share best practices, and design, implement, and evaluate interventions. OBI encourages OB Champions to use these data to understand and improve their practices, share with hospital leadership and quality improvement, and guide their internal improvement activities.

Which Michigan maternity hospitals are included in the online Obstetrics Initiative Registry?

The Obstetrics Summary Report, Maternal Outcomes Report, Maternal Utilization Report use Blue Cross Blue Shield of Michigan claims data for the 66 MVC maternity hospitals

The Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Birth Rate Report (which will be available later this summer) uses birth certificate data from the Michigan Department of Health and Human Services Vital Statistics (MDHHS) and the Michigan Hospital Association Discharge data.  The 82 Michigan maternity hospitals are included in this report.

Has the Obstetrics Initiative set a target cesarean delivery rate for participating Michigan maternity hospitals?

OBI has not set a target cesarean delivery rate using either the SMFM low risk stratification or the NTSV rate.

We are unaware of any group that has developed a target rate for the SMFM low risk stratification.  The Healthy People 2020 goal NTSV Cesarean Section rate is 23.9%.

Can a hospital verify the accuracy of their hospital’s report data?

OBI can work with hospitals to verify the accuracy of their hospital’s data.    

  • MVC has partnered with hospitals to validate claims data with great success.  MVC can provide hospitals an individual’s date of birth, admission date, discharge date, procedure type, and provider National Provider Identifier (NPI).  A hospital employee can then use these data to match patients and identify a medical record number or other specific identifier which are not available in OBI claims data.
  • OBI will share data provided to us by Michigan Department of Health and Human Services Vital Statistics (MDHHS) for your hospital for validation.  OBI does not itself hold the Birth Certificate data.

What resources are available to use for learning to use the registry?

OBI has a guide (PDF) for each of our obstetric reports, available on our Obstetrics Report page. In addition, OBI Project Manager, Nina Bobowski (npbo@med.umich.edu) is happy to have a shared-screen tutorial to walk you through how to navigate the registry and run queries.

 

MVC and BCBSM

What is the relationship between the Michigan Value Collaborative (MVC) and the Obstetrics Initiative (OBI)?

The Obstetrics Initiative (OBI) is an interdisciplinary quality improvement project within the Michigan Value Collaborative (MVC).  MVC is a collaborative quality initiative (CQI) of Blue Cross Blue Shield of Michigan (BCBSM), which aims to achieve the best possible patient outcomes at the lowest reasonable cost across Michigan hospitals. MVC is part of Blue Cross Blue Shield of Michigan’s Value Partnership collaborative quality initiative (CQI) program.  MVC includes 76 participating acute care hospitals throughout the state of Michigan.

What is the relationship between the Blue Distinction Maternity Care Program and the Obstetrics Initiative?

Blue Distinction Maternity Care Program and the Obstetrics Initiative are completely separate. The Blue Distinction Maternity Care program is a national Blue Cross Blue Shield Association program. The Blue Distinction Maternity Care Program requires facilities to apply to be considered for the Maternity Care designation under this Program. This program focuses on vaginal delivery and cesarean delivery episodes of care; routine obstetrical services and follow up care.

Are there any rewards for hospitals or physician organizations (POs) to participate in the Obstetrics Initiative? Is OBI part of the BCBSM Pay for Performance (P4P) Program?

OBI is not currently part of the BCBSM Pay for Performance (P4P) program. OBI is in discussion with BCBSM about potential rewards that may be offered to OBI participating hospitals and physicians in 2019.

 

BCBSM Claims Data

How are episode costs determined?

Hospitals will receive risk-adjusted and price-standardized measures of 30-day and 90-day episode payments around hospitalizations for common conditions and procedures. Episode costs are risk-adjusted to account for differences in case mix across hospitals. They are also “price standardized,” so measures will reflect utilization rates rather than negotiated prices/rates. Clinical services unrelated to the index admission will be excluded.

How is an episode of care defined?

An episode of care is defined by four main payment components: a facility index payment, professional payment, post-acute care payment, and readmission payment. These components are further outlined in both the “Episode of Care Payment Components Model” and Technical Document in the MVC registry (will be hyperlinked).

 How does MVC risk adjust data?

MVC performs risk-adjustment using observed/expected (O/E) ratios. The numerator in this ratio is the aggregate of all observed payments for a particular hospital. The denominator is the aggregate of all expected payments. This ratio is multiplied by the statewide expected mean payment to arrive at the “risk-adjusted payment” for that hospital.