142nd APHA Annual Meeting and Exposition

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Impact of a public-private partnership to improve the health of mothers and newborns by decreasing early elective deliveries

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 1:30 PM - 1:50 PM

Sarah Gareau, DrPH, MEd, MCHES , Division of Policy and Research on Medicaid and Medicare, University of South Carolina, Institute for Families in Society, Columbia, SC
Ana Lopez Defede, Ph.D. , Department of Family and Preventive Medicine/SOM, Institute for Families in Society, Columbia, SC
Melanie (BZ) Giese, RN , South Carolina Department of Health & Human Services, Columbia, SC
Audio (mp3) recording Recorded Presentation (mp4)
Background. Nonmedically indicated deliveries at 37-38 weeks gestation (early-term) are associated with maternal and neonatal risk.  In response, the South Carolina Department of Health & Human Services launched the Birth Outcomes Initiative to increase provider awareness and partnered with SC Blue Cross Blue Shield to implement a policy to end reimbursement for elective inductions prior to 39 weeks.

Methodology. Data from vital records, Medicaid claims, and UB-04 all-payer hospital database were linked to examine the difference and relative change in the percentage of early-term elective inductions and deliveries prior to the start of the Initiative (January-March, 2011) compared to after reimbursement had ended (April – May, 2013).  An elective induction was defined as an induction performed without one of The Joint Commission criteria for conditions possibly justifying elective delivery prior to 39 weeks.          

Results. There was an overall decrease of 3.56% in the percentage of SC births occurring at 37-38 weeks (12% relative improvement).  Early-term elective inductions dropped 5.29% for all mothers in SC (55% relative improvement).  For mothers who were Medicaid recipients, there was a 3.54% decrease in the percentage of births at 37-38 weeks (12% relative improvement) and 4.57% decrease in the percentage of early-term elective inductions (51% relative improvement). 

Conclusions. SC is the first state to partner with a private payer to end reimbursement of nonmedically indicated early-term deliveries.  This partnership may serve as a model for other states with historically poor birth outcomes as one method of improving the health of mothers and newborns.

Learning Areas:

Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Provision of health care to the public
Public health administration or related administration
Public health or related public policy

Learning Objectives:
Identify risks to mothers and newborns associated with early-term deliveries Evaluate the benefits for state-level constituents of a public-private partnership to reduce early-term deliveries Describe definitions used to identify elective inductions at 37-38 weeks gestation

Keyword(s): Women's Health, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Research Professor and Director of the Division of Mediciad Policy Research at the University of South Carolina. In this capacity, I direct the data committee ( interagency public and private stakeholders) and evaluation ( all payers data) of the SC Birth Outcomes Initiative. This presentation reflects the results derived from policy and outcomes evaluation activities. Over the past twenty years, principal or co-principal investigator on federal and state contracts addressing MCH issues.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4264.0: When the bough breaks: The impact of place, race and education on birth outcomes