Published on AJMC.

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, discussed the impact of data on lowering the state’s C-section rates, which are among the highest in the country.

High C-section rates have been a problem in New Jersey. How are hospitals and physicians using payment reform to address this problem?

New Jersey, unfortunately, has some of the highest C-section rates in the country; this is even in the case of what we would describe as “avoidable” situations, where it’s a first-time mother, the head is down, it’s a single birth. One of the reasons we even know that is because of the use of data in a transparent way done by the Leapfrog Group, which the New Jersey Health Care Quality Institute is very involved in. We are the local leader of that organization here in New Jersey. Just having that data and creating an awareness of what those rates are and then sharing those rates with physicians and nurses and showing them what their rate is, is one huge step forward that is happening now that the Quality Institute is part of.

The next step is changing the payment system, and putting into place models that will reward better outcomes. So the marriage between the data and the payment system is really where New Jersey needs to go, and I would say we’re in the early stages of that.

In these early stages, has any payer in New Jersey tried a model to reward providers for bringing down C-Section rates?

Horizon Blue Cross Blue Shield (of New Jersey) for their commercial population has had a model called an episode of care that’s been going on for a number of years. They are now just starting to take steps to develop that for the Medicaid plan. The New Jersey Health Care Quality Institute is convening all the health plans and many of the hospital systems that are providing maternity care for most of the Medicaid population, and together along with physicians and nurse midwives we are designing an episode-of-care model to supporter better outcomes for women and children, to reduce C-sections, to reduce NICU stays, and to do better when it comes to low birth weight. It’s really a collaborative process that is happening from outside the government, but we’re hoping it’s something that will be adopted by the Medicaid program moving forward.