Health systems consider maternal and infant health to be one of the most important quality improvement objectives for their organizations, according to a Premier survey conducted last spring.
Maternal and infant health, or perinatal health, ranked behind infection prevention as a priority but ahead of readmissions, post-acute care management, diabetes management and oncology care.
The heightened focus to keep mothers and babies healthy appears to be paying off. A nationally representative Premier analysis on maternal and infant health showed that more than 900 U.S. hospitals marked a 24 percent decrease in delivery-related maternal deaths between 2008-2018. Importantly, the disparity gap between black women and women of other races for inpatient delivery-related deaths has narrowed significantly. Premier identified an 80 percent decrease in maternal mortality for black women, with the gap actually closing in 2018.
While providers are vigorously striving to achieve the best care possible, Premier’s survey indicated a major opportunity for improvement: nearly two-thirds (64 percent) of respondents are limited by the lack of integrated technology to monitor, measure and report on care delivered to mothers from pregnancy through postpartum.
This is important, as Premier’s analysis also showed that severe maternal morbidity (SMM) increased by 36 percent, and in particular, black women had a 79 percent higher rate of SMM factors than white women. While the analysis found that the increase in SMM is likely being influenced by several factors, including the transition from ICD-9 to ICD-10, maternal age, payer and hospital type, increased incidence of substance use and other factors, there are still opportunities for improvement.
SMM is defined as unintended outcomes from the process of labor and delivery that result in significant short-term or long-term consequences to a woman’s health. According to the American College of Obstetricians and Gynecologists (ACOG), SMM can be considered a near miss for maternal mortality and is often a direct result of mortality as life progresses. As an increasing number of women suffer from SMM diagnoses and complications, enhanced reviews, standardized data and coordinated postpartum care will be imperative to decrease the nation’s SMM and mortality rates and, most importantly, help these patients heal. In fact, new recommendations from ACOG include guidelines to extend postpartum care.
Models that Improve Care
One way providers are successfully coordinating episodic care is through value-based care models. Value-based episodic payment models that incent care for an entire episode, such as bundled payments, are demonstrating an ability to improve care coordination, standardization, quality and costs in other areas of healthcare.
While 93 percent of survey respondents indicated that they do not currently participate in a risk-based payment model with an insurer or employer that is focused on maternal and/or infant health, addressing perinatal health through such a payment model could help support greater care coordination and a more holistic approach to managing pregnancy, labor, birth and post-partum care. This underscores the need for new payment models to incentivize integrated care across ambulatory and inpatient settings.
The industry has generally been inclined to focus improvement efforts almost exclusively in the acute care setting. To that end, respondents most commonly implement evidence-based practices to standardize care for obstetric hemorrhage, maternal venous thromboembolism (VTE), severe hypertension and safe reduction of primary cesarean birth – all acute care initiatives.
As part of this work, the industry will require the development and implementation of best practices that guide standardized, evidence-based care throughout the entire patient journey. Underscoring this need to focus across the continuum, the survey respondents identified poor health literacy, lack of education for self-care and lack of standardized care as the top contributors to their perception of maternal and infant preventable mortality and morbidity, and increased costs.
The opportunities identified in Premier’s survey and recent maternal mortality and morbidity report are being addressed through its Bundle of Joy™ Campaign, which is aimed at testing and scaling quality, safety and cost improvement in the care of mothers and babies. The campaign leverages data on 1.2 million annual births to identify key metrics that support quality improvement, as well as reporting to federal and state agencies. Additionally, as part of the campaign, 10 hospitals have come together to reach zero preventable maternal and neonatal harm and death in Premier’s Perinatal Collaborative.
Check out Premier’s data-driven analysis on maternal and infant mortality and morbidity, including breakdowns by age, race, payer and delivery method, which represents 25 percent of all births in the U.S.