OPQC Progesterone Project

Action Period Call

May 28, 2015

12:15-1:15 PM ET

Welcome!

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Progesterone Teams • AGMC's Women's Health Clinic

• Aultman Physician Center-OB/GYN Clinic

• Brown County Women's Health

• Center for Women’s Health, University of Cincinnati Medical Center

• Doctors Hospital Women's Health Center

• Faculty Medical Center—OB Resident Clinic GSH (TriHealth)

• Fairview Perinatal Department (Cleveland Clinic)

• Five Rivers Health Centers, Center for Women's Health (Miami Valley Hospital)

• MacDonald Women's Hospital Clinic (Family Practice and OB Faculty Clinic)

• Maternal Fetal Medicine at Hillcrest Hospital Atrium (Cleveland Clinic)

• Mercy OB/GYN Associates Family Care Center/ MFM Clinic

• MetroHealth Women's Clinic

• Mount Carmel St. Ann’s OB/GYN Clinic

• Mt. Carmel West Outpatient Clinic

• OSU McCampbell Clinic

• OSU Martha Morehouse MFM

• Outpatient Care Center at Grant Medical Center

• ProMedica Center for Health Services – Women’s Services (ProMedica Toledo Hospital)

• Riverside OB Community Care Clinic/ MFM Consultative Practice

• St. Elizabeth Boardman’s Health Center

• Tri-State Maternal Fetal Medicine Associates, Inc.

• Women's Health Center at Summa Akron City Hospital

12:15 PM

Welcome and objectives Introductions / KDD revisions

Martha Rome

12:25 From the Desk of Ohio’s Progesterone Navigator

Hetty Walker

12:35 Monthly Aggregate Data Jay Iams

12:40 Rapid Fire: What are you

learning from the data? Teams

1:05 Medicaid Managed Care Communication Form Test

Mike Marcotte

1:10 PM Wrap Up and Next Steps Martha Rome

Agenda

Objectives for Today’s Call

• Explore opportunities to understand data collected and graphs

• Review work with Medicaid to test a new Communication Form / PRAF

Introductions to “new” OB OPQC

team members

• Cathy Jaworski MSN RN-BC

BEACON Quality Improvement Coordinator

• Stephanie Buckler – Specialist, Project

Management OPQC

• Jennifer M. Jones (Dusing) –

Coordinator, Project Management OPQC

DRIVERS

Revision Date: 05-15

PROGESTERONE PROJECT KEY DRIVER DIAGRAM

SMART AIM

BY July 1, 2016,

DECREASE THE

RATE OF

PREMATURE

BIRTHS in Ohio

less than 37 weeks

by 10%, and less

than 32 weeks by

10%

GLOBAL AIM

IMPROVE NEWBORN

OUTCOMES BY

REDUCING

PREMATURE BIRTHS

Consistent and

early recognition of

prior preterm birth

Expedite

progesterone

supplementation

Adopt a cervical

length ultrasound

screening protocol

INTERVENTIONS

• Educate on benefits of progesterone and

use evidence-based counseling methods

• Involve key support individuals

• Connect women to insurance, home

care, social services, etc. to ensure

progesterone available &administered

• Work with Medicaid and Medicaid Plans

to identify women at risk and reduce

administrative barriers

• Create a written protocol for identified

candidates

• Start progesterone as soon as possible

(according to ACOG and SMFM

guidelines) after identification of

eligible woman

• Screen women for OB history of

preterm birth

• Align and communicate with EDs, WIC,

etc. to screen and refer when history of

preterm birth

• Facilitate rapid new OB appointments

• Postpartum counseling on

progesterone for those eligible in next

pregnancy

• Use sonographers trained in cervical

length measurement

• Develop a practice protocol to

selectively or universally screen

cervical length (consider population

risk)

Customize patient

care to start and

maintain women on

progesterone

MEDICAID AND BRANDED

PROGESTERONE -- HETTY

WALKER

Update: Rx of Makena®

for Patients on Straight Medicaid (Medicaid Fee For Service)

• New Criteria - Makena® Rx Requires ALL of the following:

1. History of prior preterm birth

2. Singleton pregnancy (no multiples)

3. Initiate no earlier than 16 weeks, no later than 24 weeks

NO Prior Authorization !

• Compounded 17 P or Vaginal Progesterone no longer preferred by Medicaid FFS

• Injection administered by a trained caregiver (may be family member)

• Approved through 36 weeks gestation

• Home care is covered if the company providing it is contracted with Medicaid – Alere is currently not contracted with Medicaid but is in process

Note: Any drug administered in office is “Buy and Bill” = a medical claim – bundle cost of drug + In Office Administration Fee, NO Prior Authorization !

Questions? – OPQC.net: click on Provider / scroll to section Progesterone as Prevention of Preterm

Birth and you’ll see the continually updated Progesterone Coverage Chart (Ohio)

– Or call Hetty Walker 614-293-8949 or email hetty.walker@osumc.edu

MONTHLY AGGREGATE DATA

– DR. JAY IAMS

Your Turn: Rapid Fire Reports

• What is your data telling you?

– Have you improved in any areas?

– What might help your team “move the dial”?

Progesterone Teams • Aultman Physician Center-OB/GYN Clinic

• MacDonald Women's Hospital Clinic (Family Practice and OB Faculty Clinic)

• Center for Women’s Health, University of Cincinnati Medical Center

• Doctors Hospital Women's Health Center

• Faculty Medical Center—OB Resident Clinic GSH (TriHealth)

• Fairview Perinatal Department (Cleveland Clinic)

• St. Elizabeth Boardman’s Health Center

• Five Rivers Health Centers, Center for Women's Health (Miami Valley Hospital)

• Maternal Fetal Medicine at Hillcrest Hospital Atrium (Cleveland Clinic)

• Brown County Women's Health

• Outpatient Care Center at Grant Medical Center

• MetroHealth Women's Clinic

• Mt. Carmel West Outpatient Clinic

• OSU McCampbell Clinic

• Mercy OB/GYN Associates Family Care Center/ MFM Clinic

• ProMedica Center for Health Services – Women’s Services (ProMedica Toledo Hospital)

• AGMC's Women's Health Clinic

• Riverside OB Community Care Clinic/ MFM Consultative Practice

• Tri-State Maternal Fetal Medicine Associates, Inc.

• OSU Martha Morehouse MFM

• Women's Health Center at Summa Akron City Hospital

• Mount Carmel St. Ann’s OB/GYN Clinic

COMMUNICATION FORM

PDSA– DR. MIKE MARCOTTE

Communication Form/PRAF

THANK YOU!

• Medicaid is testing a standard risk identification form that will eventually be used by all of the MMO’s & Medicaid FFS

• OPQC teams were asked to pilot/review form

• OPQC will review your responses with Medicaid

• Next PDSA: use form to streamline care first in 6 sites

Do

Study Act

Plan

Please Complete the Late Start

Investigations

• Review the list generated by the Data Team for Candidates that started Progesterone after 20 weeks

• Choose candidates that came in before 20 weeks, if you have them. If not, choose any 5 and ask yourselves why they came in late!

Next Steps

• Complete the Monthly Site Profile by June 5 https://portal.opqc.net/Progesterone/SitePages/Home.a

spx

• Don’t forget to complete GA after birth!

• The Monthly Progress Report (MPR) link was

sent to your Key Contact last week. Please

complete them by June 5.

• Complete the Late Start Investigations (5)

https://redcap.research.cchmc.org/surveys/?s=

NtbGiD5bvu

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