2
DISCLOSURE
• I have no financial interests or other relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. My presentation will not include any discussion of the unlabeled use of a product or a product under investigational use.
4
Leading is not Tidy
• Decisions are made and then reversed• Misunderstandings are frequent• Inconsistency is inevitable• Inside every solution are the needs of new problems• Most of the time most things are out of hand
Nonaka and Takeuchi, The Wise Leader
Will Changes in Models Force Changes in Structure and Systems?
Structure Process Outcomes
Improvement Science
Hoffer-Gittlell, Heller SchoolBrandeis University
Viab
ility
Where are you in the Model Life Cycle?
ModelsAdapted from The Second Curve, Ian Morrison 1996
Clinical Model Episodic Care Coordinated Care Patient Directed Care
Business Model Fee for Service Bundled Payment/Capitation Disruptive Innovation?
Infrastructure Segmented Integrated Cloud
Adaptive Leadership
TechnicalLeadership
Patient
Inflection Point
The Patient’s Health RecordCloud Infrastructure
Fitness Center
Home Telemetry
Pharmacy
Financial Services
Grocery Store
Hospitals
Primary Care
Home Health Care
Long Term Care Specialist
Elective Deliveries <39 Weeks Intermountain Healthcare
0%
5%
10%
15%
20%
25%
30%
35%
Month
Per
cen
t <
39 W
eeks
What is:
Elective Deliveries <39 Weeks Intermountain Healthcare
0%
5%
10%
15%
20%
25%
30%
35%
Month
Per
cen
t <
39 W
eeks
And what can be:
13
Opportunities
• Each week 174 babies premature• VLBW babies in South Carolina= $107 million per year.• Over a thousand VLBW births per year • 235 VLBW cases are multiple birth deliveries • Small number but over 50% of hospital charges
15
Louisiana Philosophy
We strive to improve health and health care by:
– Using the “Lifecourse” theory– Motivating and building will for change with hope and
optimism– Consensus, consensus, consensus
Louisiana Rankings
Indicator US Louisiana Rank
Preterm birth (< 37 weeks gestation, %) 12.3 15.4 48th
Low Birth Weight (< 2,500 grams, %) 8.2 10.8 49th
Very Low Birth Weight (< 1,500 grams, %) 1.5 2.1 48th
C-section rate (%) 32.3 38.0 49th
Infant Mortality (<1 year old, per 1000 live births)
6.75 9.17 46th
Source: Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National vital statistics reports; vol 59 no 1. Hyattsville, MD: National Center for Health Statistics. 2010.
17
Interventions to Improve Birth Outcomes
Increase use of
smoking cessation treatment
Increase use of
17P
Reduce preterm & repeat C-section
New indicators
for hospital quality
monitoring Risk assessment
and care plan for
women with adverse outcome
Infant
Chronic disease
management
Screening and treatment for behavioral
health
Early and Adequate Prenatal
Care
Home Visitation (Healthy
Start, NFP)
Intensive care
coordination/case
management
FIMR
Family planning
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Top Down
• Tony Keck• Louisiana Department of Health and Hospitals• Louisiana Perinatal Commission
– Authorized in 2006, 16 member commission appointed by Governor Jindal
• Blue Ribbon Panel
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Bottom Up
Birth Outcomes State Wide Action Teams • Five action teams which represent community partners,
consumers, advocates, public health professionals, clinicians, hospital administrators, and insurers
» Care Coordination» Health Disparities» Patient Safety and Quality» Behavioral Health» Data and Measurement
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Ideas
"Ideas are like rabbits. You get a couple and learn how to handle them, and pretty soon you have a dozen."
-- John Steinbeck
21
Birth Outcomes Priorities
• Increase Data Capacity and Performance Measurement
• Institute statewide comprehensive Behavioral Health screening
and brief intervention for pregnant women in Medicaid
• Pilot and expand access to Interconception Care Coordination
• Increase Patient Safety and Quality of Care
23
Patient Safety and Quality of Care
To create a culture of continuous quality improvement and safety in
Louisiana’s birthing hospitals.
PERFORMANCE
Indi
vidu
al A
uton
omy
Guidelines as defined by professional standards Legal space
Usual spaceof action
Illegal-normalspace
the ‘illegal-illegal’ space (for almost all of us!)
VE
RY
UN
SA
FE
SP
AC
E IndividualPressures
PerceivedVulnerability
Belief inSystems-guidelines
<1% 5% 50% 80% 100% percent of staff
Safety regs & good practices
Certification/ accreditation
standards
Collective memory of experiences
Forbiddenbehavior except under extreme circumstances
Forbiddenby all
55 55 in a in a 5555
75 75 in a in a 5555
95 95 in a in a 5555
115 115 in a in a 5555
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Data and Measurement
Create transparency, accountability and quality improvement infrastructure for perinatal quality improvement measurement and reporting.
31
Perinatal Quality Scores
• Pre-term births• VLBW by level NICU • Nulliparous term singleton vertex C-sections (NTSV)• Elective deliveries < 39 weeks gestation
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Behavioral Health
Ensure that all women in Medicaid receive a behavioral health screen, brief intervention referral and treatment for substance use,
depression and violence
35
Care Coordination
To provide care coordination for every woman in Louisiana Medicaid who has had an adverse pregnancy outcome
Viab
ility
Where are you in the Model Life Cycle?
ModelsAdapted from The Second Curve, Ian Morrison 1996
Clinical Model Episodic Care Coordinated Care Patient Directed Care
Business Model Fee for Service Bundled Payment/Capitation Disruptive Innovation?
Infrastructure Segmented Integrated Cloud
Adaptive Leadership
TechnicalLeadership
Patient
Inflection Point
Department of Health and Hospitals
Louisiana Birth Outcomes Initiative
DHH Bienville Building
628 N. 4th Street
Baton Rouge, Louisiana
(225) 342.9500
Website: www.dhh.la.gov
The Birth Outcomes Initiative
Rebekah Gee, MD, MPH, MS, FACOG
Director of Birth Outcomes
Michelle M Alletto, MPA
Deputy Director
Bruce Greenstein, Secretary
Kathy Kliebert, Deputy Secretary
Jerry Phillips, Undersecretary
This document was published in-house by the DHH Office of Birth Outcomes
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