How to Integrate Midwives to Improve Outcomes...How to Successfully Integrate Midwives into Your...

How to Integrate Midwives to Improve Outcomes

2018 Midwifery Works

SIMPLE POWER POINT PRESENTATION

October 12, 2018

Tools to download at

www.pbgh.org/midwifery

Agenda• Introduction and Background

• Methodology of Tool Design

• Key Learnings and Discussion

• Tool Overview

• Real World Scenario Discussion

• Next Steps

• Q+A

3

*Silicon Valley Employers Forum represents an additional 43 high-tech employers

Pacific Business Group on Health

Maternal Health in the U.S.

5

Poor outcomes

Unnecessary care

High spend

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

6

Given the benefits of midwifery, why do CNMs only deliver 9% of babies in

California?

How to Successfully Integrate Midwives into Your Practice 7

Overview of Barriers Analysis

Policy

Organizational

Interpersonal

Personal

• Legislation/regulatory

• Hospital

• Payer

• Liability insurers

• Obstetricians

• Consumers

How to Successfully Integrate Midwives into Your Practice 8

• To change the prevailing medical culture around maternity care and create an environment where all women can choose a midwifery model of care.

Vision

9

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

10

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

11

Tool Development

12

Study real working models to

13

Objective 1

Demonstrate $$ value CNMs offer maternity care practices/hospitals

Objective 2

Identify and share best practices in midwife-physician collaboration

14

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

Tools to download at

www.pbgh.org/midwifery

Key Learnings

17

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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

Started with Strategic Planning

19

Defined critical elements of practice design

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21

Demand exists for resources on how to establish new midwifery practices AND strengthen existing midwifery practices.

Learning

Designed Guide to Meet Diverse User Needs

22

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The value of midwifery often transcends dollars and cents.

Learning

24

Other Key Value Factors

Quality

Access

Patient satisfaction

Clinician burn-out

Market growth

How to Successfully Integrate Midwives into Your Practice

Strategic Steps to Develop a Business Plan

25

On page 14 of the Guide

Tools Overview

27

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

29

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

How to Successfully Integrate Midwives into Your Practice

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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

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

How to Successfully Integrate Midwives into Your Practice

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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.

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

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

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

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

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

Discussion

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Discussion

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How do you think you will apply these

tools in the real world?

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?

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

What’s Next

45

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

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

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?

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

51

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