Coordination of Care: Recommendations and Action Steps

1. Extend the health care home model to the full episode of maternity care to ensure that every childbearing woman has access to a Woman and Family-Centered Maternity Care Home that fosters care coordination.

  • Encourage the National Committee for Quality Assurance to develop standards for Woman- and Family-Centered Maternity Care Home, recognizing that family physicians and obstetricians, midwives with national credentials (CNM, CM, CPM) and nurse-practitioners all have the potential to provide exemplary maternity care coordination.
  • Call for Medicaid demonstrations to develop, evaluate, and refine the concept of Woman- and Family-Centered Maternity Care Home, including ways of restructuring health system relationships, risk-adjusting payments, providing payments for outliers, and providing consumer incentives to choose higher value caregivers and services.
  • Work with Center for Healthcare Quality and Payment Reform to adapt the care coordination, health care home and payment model outlined in From Volume to Value: Transforming Health Care Payment and Delivery Systems to Improve Quality and Reduce Costs (Miller, 2008) to the full episode of maternity care, with a focus on aligning incentives with high-quality care and delivering appropriate care, including primary maternity care for healthy low-risk women. (See the Blueprint section on Payment Reform to Align Incentives with Quality.)
  • Present the MACPAC with data about women’s experience of care, quality concerns with maternity care, and implications for Medicaid programs and beneficiaries, and seek its support for demonstrations of the Woman- and Family-Centered Maternity Care Home model.
  • Engage the support of the National Priorities Partners as this model advances five of their six priority areas, including Care Coordination.

2. Develop local and regional collaborative quality improvement initiatives to improve clinical coordination at the community level.

  • Health systems, with support from national quality organizations, should sponsor and fund projects for the development of models for effective community coordination of maternity care.
  • Health care delivery systems should establish and maintain mechanisms for open access to maternal–fetal medicine specialists by community maternity care providers for consultation, co-management, or referral of clients, as warranted, on a 24-hour basis.
  • Conduct multidisciplinary periodic review of all transfers and complications from community facilities to higher levels of care to engage team members at all levels of care in working together to jointly improve care coordination and quality.
  • A national health policy organization should seek nominations for exemplary model systems where maternity care coordination has been established and has demonstrated success (such as birth centers with tertiary referral, community hospitals with midwifery model of care and referral, and home birth services with consultation and referral to medical care) and develop and disseminate a white paper to characterize essential components of successful maternity care coordination across time, settings, and disciplines.

3. Develop consensus standards for appropriate care level and risk criteria.

  • Health systems and community providers should work together to develop consensus standards for appropriate care level and risk criteria for each setting and provider type that can be shared and reviewed periodically. Such standards should include a mechanism for exceptions and approval of clients who fall outside specific risk criteria for each setting.
  • Replicate the model and process used by Intermountain Healthcare to develop community consensus standards by convening an interdisciplinary team of family practice, midwifery, obstetric, and maternal–fetal medicine providers and using patient safety data on near misses and reportable adverse events to develop criteria appropriate to each level of care (including appropriate providers and settings).

4. Support development and use of EHRs and health information exchange systems that promote active communication among caregivers and facilities, include adequate protections for privacy and security, and put the woman and her family at the ‘‘center.’’ (See the Blueprint section on Development and Use of Health Information Technology.)

Lead Responsibilities

Key stakeholders include consumers and advocates, payers and purchasers, clinicians and health professional organizations, state and federal agencies, health systems, researchers, the National Committee for Quality Assurance, and the National Priorities Partnership.

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Reference

Miller, H. D. (2008). From volume to value: Transforming health care payment and delivery systems to improve quality and reduce costs. Recommendations of the NRHI Healthcare Payment Reform Summit. Pittsburgh, PA: Network for Regional Healthcare Improvement. Available at: http://www.rwjf.org/pr/product.jsp?id=36217.