Maternity Care

Smart Care California: Focus on C-Sections

Smart Care California is a public-private partnership working to promote safe, affordable health care in California. One of the group's primary focus areas is C-sections. While life-saving in certain cases, C-sections can pose serious risks to both babies and mothers, and once a woman has a cesarean, about 9 in 10 end up having a C-section for subsequent births, increasing their risk of major complications. Efforts to improve maternity care are starting to yield positive results in California as low-risk, first-birth C-section rates have begun to decline, but significant overuse of this surgical procedure and unwarranted variation persists. The range for low-risk, first-birth C-section rates in California hospitals spans from below 15% to over 60%. Through the Smart Care California initiative, the state’s largest public and private health care purchasers are working with hospitals and clinicians to reduce low-risk, first-birth C-sections across the state at every hospital to 23.9%, thereby improving maternity care. IHA convenes and coordinates the partnership with funding from California Health Care Foundation. 

Maternity Care Measurement at the Physician Organization Level

Increasing numbers of healthy women are undergoing obstetric procedures such as cesareans, repeat cesareans, and early elective deliveries when they may not be medically indicated, practices that result in a higher rate of complications for mothers and babies. With more than 500,000 births every year in California, there is a compelling need to reduce unnecessary interventions and deliver appropriate, evidence-based care.  Standardized performance measurement is needed to accelerate progress, increase transparency, and drive quality improvement. IHA stakeholders have identified maternity care as a priority area for Value Based P4P and for the Cost & Quality Atlas. With funding from the California Health Care Foundation, IHA will complete testing and analyses needed to support maternity care measurement at the physician organization and regional levels.

California SIM Maternity Care Initiative

The Maternity Care initiative, one of four key initiatives included in California's State Innovation Model (CalSIM) grant, promotes healthy, evidence-based obstetrical care to reduce the quality shortfalls and high costs associated with unnecessary cesarean deliveries. IHA provided technical assistance to the California Health and Human Services Agency, to further develop the four components of the Maternity Care Initiative. As a part of our work, IHA identified patient engagement strategies that enable pregnant women to make informed decisions to improve their care, their health and the health of their babies.  Additional details are provided in the resources listed below.

Issue Brief: Maternity Care Patient Engagement Strategies

Patient Engagement Matrix

CalSIM Maternity Care Initiative for Health Plans & Hospitals – Working Draft (April 2014)

CalSIM Maternity Care Initiative FAQ

Maternity Care Bundled Payment

Maternity care is suitable for a bundled payment strategy based on high volume, high costs, and a defined episode of care. Unlike fee-for-service reimbursement, which pays providers for each service, bundled payment combines services provided during a defined episode of care into a single, fixed payment rate.  Bundled payment creates financial incentives for providers and hospitals to be more accountable for efficiency and coordination across care settings.  For more information on maternity care bundled payment, download the following publication:

Issue Brief: Transforming Maternity Care: A Bundled Payment Approach

Maternity Episode Definition: Case Rate Delivery Only

Maternity Episode Definition: Pregnancy and Delivery (Mother Only)