Childbirth initiative will improve care, cut costs

A new Minnesota Health Care Programs (MHCP) policy to improve the health of newborns while reducing spending took effect Jan. 1 with positive responses from providers. The Evidence-based Childbirth Program aims to reduce the number of induced deliveries before 39 weeks gestation that are not medically necessary by encouraging providers to review care practices and establish new policies where needed.

"Children do best when they develop in utero at least 39 weeks," said Jeff Schiff, MHCP medical director. The American College of Obstetrics and Gynecology established this as a best practice more than a decade ago — the so-called 39 week rule — yet the numbers of such early-term inductions and Cesarean sections locally and nationally grew. Research shows induction before 39 weeks results in more emergency Cesarean sections, and in more newborn admissions to intensive care units.

MHCP pays for about 27,000 deliveries each year, or 38 percent of all births in Minnesota. "That's 27,000 reasons that we should do everything we can to help these newborns get off to a healthy start," Schiff said.

The initiative established in 2011 state law asks hospitals to create policies to minimize induced deliveries before 39 weeks, particularly by prohibiting scheduling such inductions when not medically necessary. In addition, facilities are asked to create quality improvement approaches that focus on reducing the occurrence of such births by reviewing the medical indications for all inductions occurring before 39 weeks.

More than 60 hospitals – accounting for more than half of MHCP births – submitted policies to DHS for review in the first three months. Doctors who deliver babies at hospitals that do not have approved policies must complete an additional form about the gestational period and type of delivery before the claim will be paid. Hospitals are also required to submit birthing data annually. HCA staff will analyze the data to see if the policy is changing the trend line for inductions.

The estimated savings from this initiative is $2.3 million in state funding for the 2012-13 biennium. Several units helped get the program up and running including benefit policy, provider relations, managed care and systems staff. The department's Health Services Advisory Council and its Perinatal Practices Advisory Group provided guidance and will monitor the results. 

The Minnesota chapter of the March of Dimes is also a key partner in this initiative, and the national organization has launched an education campaign on the benefits of 39 weeks gestation.

All Minnesotans stand to benefit from the momentum created by this state initiative. "By nudging providers in the right direction, we can really have an effect on care practices overall," Schiff said. "Our newborns will be healthier, parents will be happier and everyone’s costs will go down."