ACHP Webinar with March of Dimes Community Health Plan Strategies for Reducing

Preterm Birth

February 18, 2015

Overview of the Group• Edward McCabe, M.D., PhD, Senior Vice President and Chief Medical Officer, March of Dimes

• H. Edward Hanway, Member, March of Dimes Board of Trustees and former President, CIGNA Corporation

• Joanie Y. Hare, M.D. F.A.C.O.G., Houston Perinatal Associates; Medical Director of Perinatal Diabetes Program and Maternal Transport Program, The Woman’s Hospital of Texas

Today’s Presenters

2

March of Dimes: Why Prematurity?

Ed McCabe, MD, PhDSenior Vice President and

Chief Medical OfficerMarch of Dimes Foundation

Overview

• March of Dimes Mission• Burden of Prematurity• Preventing Preterm Birth• Summary

MARCH OF DIMES MISSION

Mission Statement

Improving the health of babies by preventing birth defects, premature birth, and infant mortality

BURDEN OF PREMATURITY

Prematurity Campaign

“In January 2003, the March of Dimes made a public commitment of resources and reputation to confront the most serious perinatal health problem in our nation: preterm birth.”

Prematurity Campaign: 10-Year Anniversary Report. MOD. 2013

Prematurity Campaign

• Where the US started 2002 – 12.1% and rising for 2 decades 2006 – 12.8% and the peak

• Goals 2020 – 9.6% or lower 2014 – 8% reduction in each stateoInterim goal energized by ASTHO

President’s Challenge

Consequences of Increased PTB

• Over one third of infant deaths were thought to be related to LPTB (34-36 weeks gestation)

• Infants born late preterm had increased risks of early death and long-term consequences

Martin et al. 2009. Nat Vital Stat Rep; 57(7):1-104

LPTB and the NICU

• LPTB results in the Largest proportion of

babies in the NICU Most of the NICU costs

Ramachandrappa and Jain. 2009. Ped Clin N Am; 56:565-570

Infant Mortality

• In 2008 Full term (39-41 weeks)o2.08/1,000

Early term (37-38 weeks)o3.14/1,000

Late preterm (34-36 weeks)o7.40/1,000Mathews and MacDorman. 2012. Nat Vital Stat Rep; 60(5)

PREVENTING PRETERM BIRTH

Preterm Birth Rates by Gestational AgeUnited States, 1990, 2000, 2005-2013*

1.92 1.93 2.03 2.04 2.04 1.99 1.97 1.96 1.93 1.93 1.92

1.40 1.49 1.60 1.62 1.60 1.57 1.55 1.53 1.52 1.49 1.48

7.308.22

9.09 9.15 9.04 8.77 8.66 8.49 8.28 8.13 7.99

0

2

4

6

8

10

12

14

1990 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013*

VPTB (<32 wks) 32-33 wks LPTB (34-36 wks)

Percent of live births

12.212.312.712.812.711.6

10.6

* Preliminary DataSource: National Center for Health Statistics, 1990-2012 final natality data and 2013 preliminary dataPrepared by March of Dimes Perinatal Data Center

12.0 11.7 11.5 11.4

Prematurity Awareness Month &World Prematurity Day

• Annual Report Cards• Celebrities• Lightings• Media – Impressions 2013

o2.6B Domesticallyo4.3B Internationally

Niagara Falls

Decreasing LPTB

• 39 Weeks “Hard Stop” Initiative Reduce elective inductions and c-sections before

39 weeks MOD, working with 25 hospitals, reported 83%

reduction of Early Elective Deliveries (37-38 weeks) from January to December

• Estimate eliminating EEDs could reduce PTBs by ~20%

Healthy Babies are Worth the Wait

“This initiative (started in Kentucky) provides evidence that an effective collaborative model can be devised involving clinical and public health professionals, hospitals, and community organizations.”Volume 1, MOD Series (Elsevier)

Cost of Prematurity to Business

More than 12X

Newborn Care: Average Employer Health Plan Expense

Cost of Prematurity to Business

• Looking at this as a Wellness Program for businesses• Healthy Babies Healthy Business Employers - 475

• Business, Babies and the Bottom Line Engaging CEOs and their HR Teams

SUMMARY

Fewer preterm births

Potential cost savings(in billions)

Preterm birthrate(% of live births)

231,000 fewer babies born preterm

$11.9 billion saved

Preterm Birth Reductions

*Preliminary dataSource: Preterm birth rates—National Center for Health Statistics, 2006 – 2012 final and 2013 preliminary natality dataFewer preterm births—calculated as the reduction in preterm birth rate since 2006 times the number of live births per year.Potential cost savings—based on estimated number of fewer preterm births and the average societal costs due to preterm birth from the Institute of Medicine, 2007.Prepared by March of Dimes Perinatal Data Center, June 2014.

Preventing PTB

• March of Dimes showed that PTB could be reduced Education and awarenessoPremature birth matters

Hospital-based strategieso39 Week “Hard Stop”

Preventing PTB

• March of Dimes showed that PTB could be reduced Community-based programs

oHealthy Babies are Worth the Wait

Prematurity Cost to BusinessoHealthy Babies Healthy BusinessoBusiness, Babies and the Bottom Line

Health Plans

• We welcome the opportunity to work with a health plan and its members to evaluate and refine our strategies to reduce PTB

• Just as we have done with hospitals and communities

Healthy Babies are Worth the Wait®

A Signature Program of the March of Dimes

Healthy Babies are Worth the Wait Community Program

• March of Dimes chapter-led, community program aimed at reducing preterm birth.

• Partnership among key entities: March of Dimes chapter, health department, clinic/hospital, and the community.

• Includes these critical elements: clinical & public health interventions, provider/patient education, and community awareness.

• Efforts are focused on results and include process and pregnancy outcome measures. measures.

Target Community

• Increase access to prenatal care•Strengthen care coordination for patients

•Optimize access to evidenced- based interventionsClinicians/

Providers

Public Health Professionals

Pregnant women

LocalStakeholders

Community Members

Preterm birth reductions

Healthy Babies are Worth the WaitDemonstration Project

• 3-year initiative (2007-2009)

• Partners Johnson & Johnson, March of Dimes, Kentucky Department for Public Health

• Multi-faceted, “real world,” ecological design that uses evidence-based clinical and public health interventions to prevent preterm birth

• Goal: 15% reduction in rates of singleton inborn preterm births in 3 communities in Kentucky

Healthy Babies are Worth the WaitKey Findings

HBWW was developed to test if clinical and public health collaborations implemented through bundled healthcare delivery interventions could decrease preterm births in selected communities in Kentucky.

“This initiative provides evidence that an effective collaborative model can be devised involving clinical and public health professionals, hospitals, and community organizations.”

Healthy Babies are Worth the WaitKey Findings

Singleton preterm birth rates in the Intervention Sites declined 12.1% over the study period, from 15.7% at baseline to 13.8% during the post-implementation period.

Healthy Babies are Worth the Wait®

A Signature Program of the March of Dimes

Healthy Babies are Worth the Wait

Current (Feb. 2015)

• Kansas – 7 sites

• Kentucky – 9 sites

• New Jersey – 2 sites

• New York – 4 sites

• Texas – 4 sites

Upcoming in 2015:

• California

• Florida

• Illinois

HBWW HoustonJoanie Hare, MD

17P Workgroup Chair &

HBWW Houston Advisory Board Chair (2011-2014)

March of Dimes Affiliations

•Three “competing” hospitals came together to make up Houston’s HBWW sites. Hospital and clinic partnerships include:

• Memorial Hermann Southwest Hospital/Clinica Hispana,

• The Woman’s Hospital of Texas/Kelsey-Seybold Clinic,

• St. Joseph Medical Center/Legacy Southwest Clinic

•These three hospitals network together deliver more than 16,000 babies annually.

The Beginning

Physician Champion

• MCH Leader• Spearhead

Discussions and Projects

• Reinforce HBWW Key Messages

• Hard Stop Supporter• Quality

Improvement

• Organizational Buy-in

• March of Dimes Presence

Mission Supporter Policy

PioneerPatient Advocate

Houston’s Impact

Since launching in 2011, HBWW Houston has used the 5-P framework to improve processes and to guide work of the Advisory Board and subsidiary committees. We continue to see impact within the original 5-P framework with significant impacts in the following areas:

• Members of the HBWW Advisory Board reported an increased in collaboration focused on perinatal outcomes across the Houston area. These collaborations extended beyond board members and continue to expand. (e.g. (MCO, 17P, EEPNC Workgroups)

Partnerships/Collaborations

•Participating hospitals reported that the March of Dimes program helped them to more smoothly implement the hard stop protocols and facilitated public relations with attending obstetricians.( e.g. Grand Round/Provider Conferences)

Providers/Patients

•Participating clinic sites improved outreach for early entry into prenatal care and procedures for presumptive eligibility (e.g. Early Entry into Prenatal Toolkit; “Go Before You Show”)

Progress/Process

Houston’s Lesson Learned

One lesson we have learned that will help other communities in their implementation of HBWW?

Be flexible but keep the goal in mind!

Reduce Preventable Preterm Births

Public

ProvidersPatients

Questions and Discussion

lcuppernull@achp.orgPhone: 202-785-2247 www.achp.org

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