How to Integrate Midwives to Improve Outcomes...How to Successfully Integrate Midwives into Your...
Transcript of How to Integrate Midwives to Improve Outcomes...How to Successfully Integrate Midwives into Your...
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How to Integrate Midwives to Improve Outcomes
2018 Midwifery Works
SIMPLE POWER POINT PRESENTATION
October 12, 2018
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Tools to download at
www.pbgh.org/midwifery
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Agenda• Introduction and Background
• Methodology of Tool Design
• Key Learnings and Discussion
• Tool Overview
• Real World Scenario Discussion
• Next Steps
• Q+A
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*Silicon Valley Employers Forum represents an additional 43 high-tech employers
Pacific Business Group on Health
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Maternal Health in the U.S.
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Poor outcomes
Unnecessary care
High spend
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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
PBGH’s Transform Maternity Care Priorities
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Given the benefits of midwifery, why do CNMs only deliver 9% of babies in
California?
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Overview of Barriers Analysis
Policy
Organizational
Interpersonal
Personal
• Legislation/regulatory
• Hospital
• Payer
• Liability insurers
• Obstetricians
• Consumers
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• To change the prevailing medical culture around maternity care and create an environment where all women can choose a midwifery model of care.
Vision
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TMC’s Midwifery Blueprint for Action
Strategy 4: Harness Consumer Demand
Strategy 5: Expand Birth Centers
Strategy 1: Make the Business Case
Strategy 2: Scale Best Practices in Collaborative Care
Strategy 3: Promote Uptake of Payer Best Practices
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Building the Foundation for Transformation
Materials available at www.pbgh.org/midwifery.
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
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Tool Development
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Study real working models to
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Objective 1
Demonstrate $$ value CNMs offer maternity care practices/hospitals
Objective 2
Identify and share best practices in midwife-physician collaboration
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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
How to Successfully Integrate Midwives into Your Practice
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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 OwnedMidwifery
OwnedHospital/
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)
LargeSmall
720 BirthsMedium
875 birthsSmall
540 birthsLarge
2500 birthsLarge
1097 birthsLarge
2160 births
How to Successfully Integrate Midwives into Your Practice
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Tools to download at
www.pbgh.org/midwifery
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Key Learnings
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While midwifery can thrive in a variety of practice models and settings, organizations are generally not strategic in their design of the model.
Learning
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Started with Strategic Planning
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Defined critical elements of practice design
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Demand exists for resources on how to establish new midwifery practices AND strengthen existing midwifery practices.
Learning
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Designed Guide to Meet Diverse User Needs
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The value of midwifery often transcends dollars and cents.
Learning
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Other Key Value Factors
Quality
Access
Patient satisfaction
Clinician burn-out
Market growth
How to Successfully Integrate Midwives into Your Practice
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Strategic Steps to Develop a Business Plan
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On page 14 of the Guide
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Tools Overview
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28How to Successfully Integrate Midwives into Your Practice
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
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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
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Business Planning White Paper
4. Develop a business plan
3. Develop a Pro Forma
2. Consider Resource Allocation
1. Assess Current and Evolving Landscape
How to Successfully Integrate Midwives into Your Practice
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31How to Successfully Integrate Midwives into Your Practice
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
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Estimates the financial value of adding a CNM into maternity care practice based on practice type and practice-specific characteristics
Pro Forma Projection Tool
How to Successfully Integrate Midwives into Your Practice
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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
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Tool Outputs
How to Successfully Integrate Midwives into Your Practice
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.
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35How to Successfully Integrate Midwives into Your Practice
Midwifery Integration
Guide
Funded by the Yellow Chair Foundation
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Part 1: Secure Support
Part 2: Establish the Practice
Part 3: Create a High-Performance Practice
Part 4: Create a Plan to Monitor Success
How to Successfully Integrate Midwives into Your Practice
Midwifery Integration Guide
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37 How to Successfully Integrate Midwives into Your Practice
Midwifery Integration Guide
Part 1: Secure
Support
Step 1: Gather Info
Step 2: Engage Stakeholders
Step 3: Make a Business Plan
Step 4: Assemble Key Stakeholders
Step 5: Develop Strategic Plan
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38 How to Successfully Integrate Midwives into Your Practice
Midwifery Integration Guide
Part 2: Establish the
Practice
Step 1: Define Roles
Step 2: Build the Model
Step 3: Build the Brand and Communication Materials
Step 4: Select and Hire
Step 5: Prepare to Onboard
Step 6: Orientation
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39 How to Successfully Integrate Midwives into Your Practice
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
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40 How to Successfully Integrate Midwives into Your Practice
Midwifery Integration Guide
Part 4:Create a Plan
to Monitor Success
Step 1: Ensure Financial Success
Step 2: Monitor Outcomes
Step 3: Integrate Learners
Step 4: Recognize and Celebrate Success
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Discussion
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Discussion
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How do you think you will apply these
tools in the real world?
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Discussion
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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?
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Discussion
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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
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What’s Next
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TMC’s Midwifery Blueprint for Action
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Strategy 4: Harness Consumer Demand
Strategy 5: Expand Birth Centers
Strategy 1: Make the Business Case
Strategy 2: Scale Best Practices in Collaborative Care
Strategy 3: Promote Uptake of Payer Best Practices
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BA Grand Rounds Series Recruiting for sites and midwife-physician speakers this fall!
Disseminate the Guide
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Promote Payer Best Practices
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Assess health plan practices
Create menu of purchaser and payer best practice options
Promote uptake
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Accelerate Employer Influence
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Launch maternity centers of excellence Can we establish direct contacts between employers and high performing facilities with midwives?
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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
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Questions
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Feedback