Birth Certificate

Pregnancy Medical Homes

 2003 standard U.S. birth certificate
 NC is 38th state to implement; all hospitals on board
by December 2010
 Web-based data entry program
 Old birth certificate has 43 questions
 New birth certificate has 58 questions, 9-page
worksheet of clinical info, 5-page mother’s worksheet
 Almost all of the new data is clinical
◦ IVF, induction, augmentation, chronic hypertension vs.
gestational
 More information on www.pqcnc.org, including two-
page worksheet for clinical information
 Good birth certificate data benefit all of us!
A partnership with
Community Care of North
Carolina, Division of Medical
Assistance and Division of
Public Health
 Improve birth outcomes in North Carolina by
providing evidence-based, high-quality
maternity care to Medicaid patients
 Improve stewardship of limited perinatal
health resources
 Reduce preterm birth rate, rate of low birth
weight, cesarean section rate
 DMA/DPH/CCNC steering committee
 DMA project team
 CCNC OB workgroup
◦ Perinatologists, obstetricians, midwife, family medicine
◦ Local health departments
◦ DPH Women’s Health Branch
◦ Division of MH/DD/SA
◦ Division of Medical Assistance
◦ Local CCNC network leadership
 DPH Women’s Health Branch team
AccessCare Network Sites
AccessCare Network Counties
Access II Care of Western NC
Access III of Lower Cape Fear
Carolina Collaborative Comm. Care
Carolina Community Health Partnership
Central Piedmont Access II
Comm. Care Partners of Gtr. Mecklenburg
Community Care Plan of Eastern NC
Community Health Partners
Northern Piedmont Community Care
Partnership for Health Management
Sandhills Community Care Network
Southern Piedmont Community Care Plan
Community Care of Wake and Johnston Counties
Central Care Health Network
 Any current provider of maternity care will be able
to sign an agreement with a CCNC network to
become a Pregnancy Home:
 OB/GYN practices
 Family medicine
 Certified nurse midwives
 Nurse practitioners
 Local health departments
 Federally qualified health centers
 May or may not also be a CCNC/Carolina Access
Primary Care Medical Home
 Provide comprehensive, coordinated maternity care to
pregnant Medicaid patients and to allow chart audits for the
evaluation purposes for quality improvement measures
 Four performance measures:
◦ No elective deliveries <39 weeks
◦ Offer and provide 17P to eligible patients
◦ Reduction in primary c-section rate
◦ Standardized initial risk screening of all OB patients,
 Provide information on how to obtain MPW, WIC, Family
Planning Waiver
 Collaborate with public health Pregnancy Care Management
programs to ensure high-risk patients receive care
management
 Data-driven approach to improving care and outcomes,
including practice-based report with comparison data
 Incentives:
◦ Increased rate of reimbursement for global fee for vaginal
deliveries to equal that of c-section global fee (similar
increase for providers who do not bill global fee)
◦ $50 incentive payment for initial risk screening
◦ $150 incentive payment for postpartum visit
◦ No prior authorization required for OB ultrasounds (but still
must register with MedSolutions)
 Support from CCNC network/NCCCN, Inc.
◦ Example: pharmacy working group re: 17P and long-acting
contraceptives
 Network is accountable to DMA for outcomes of this
initiative (pregnancy medical homes and pregnancy care
management)
 Each network to have an OB team:
◦ OB coordinator (nurse) and
◦ OB clinical champion (physician)
 OB team will:
◦ educate and recruit practices
◦ work with providers and other local agencies to make the
system changes necessary for program
◦ provide technical and clinical support to participating
pregnancy homes and to OB case management
 Risk criteria include a
combination of medical
risk, psychosocial factors,
and utilization (or lack
thereof)
 Positive risk screen will
trigger case management
assessment
 Risk screening to be
performed at first OB visit;
follow-up screen at end of
2nd trimester and anytime
new risk factor may be
present
Priority risk factors:
 History of preterm birth
 History of LBW
 Substance abuse
 Tobacco use
 Chronic disease which may
complicate pregnancy
 Unsafe living environment
 Late entry to prenatal care
 Missing 2 or more prenatal appts
 Partnership with public health
 Change from current MCC Program paradigm of all
Medicaid-eligible patients to focusing on those with
risk factors for poor birth outcome
 Care managers assigned to cover OB practices
 Care managers will use CCNC’s Case Management
Information System software
 Coordination with the CCNC network’s OB team
 Support from state DPH team