On Oct. 15, leaders at the Charlotte, N.C.-based Premier Inc. announced a new, two-year, $8 million national partnership with the U.S. Department of Health and Human Services (HHS) Office of Women’s Health, to leverage Premier’s data and its performance improvement methodology, to develop a collaborative program to help hospital and health system leaders to improve maternal and child health outcomes nationwide.
In a press release published on Thursday to the organization’s website, Premier leaders stated that, “Over the course of the partnership, Premier and the HHS Office of Women’s Health will leverage Premier’s data, which represents 45 percent of U.S. hospital discharges, to analyze the risk factors affecting maternal morbidity and mortality – such as rising maternal age, racial and ethnic disparities, socioeconomic factors and comorbidities. In addition, HHS and Premier will unite a cohort of at least 200 hospitals to join Premier’s data-driven Perinatal Collaborative. Premier will implement standardized, evidence-based practices and care bundles with collaborative members, measuring outcomes to identify and scale the most effective practices.”
And it quoted Susan DeVore, Premier’s CEO, as stating that “Premier has long been a passionate advocate of putting mothers and babies at the center of care. We are honored to partner with HHS, which selected Premier for our gold-standard healthcare data, unmatched measurement and analytics capabilities, and proven track record of quality improvement. We look forward to working alongside HHS to make America the safest place in the world to give birth,” DeVore said.
The press release went on to not that “The nation’s current maternal health surveillance system relies on voluntary, self-reported data from states, resulting in inconsistent and delayed reporting of outcomes and health trends. In addition, the U.S. process does not routinely track data that connects outcomes to known causes of maternal harm and death. Premier’s data is timely, standardized, accurate and comprehensive, and drills into hundreds of maternal and infant health outcome measures at the time of delivery, allowing for precise analysis of clinical and demographic influences. Using Premier’s extensive database and Perinatal Quality Dashboard, Premier members can correlate health factors with mortality and morbidity, enabling actionable intelligence that has proven to improve quality and safety.”
In addition, the press release noted that, “Via a data-driven collaborative of more than 200 hospitals, Premier will utilize HHS-defined criteria to engage a nationally representative sample of U.S. birthing hospitals – including those that serve geographic locations with high mortality rates and that represent racially and ethnically diverse patient populations, such as Pennsylvania-based Universal Health Services and Maryland-based LifeBridge Health. The initiative will also include collaboration with the MoMMA’s Voices Coalition to ensure patient perspectives from all social and racial populations are captured.”
And, the press release noted, “The initiative with HHS will provide research on the correlation between a mother’s health risks and the ensuing effect on her baby – building on Premier’s decades of experience working with providers to reduce mortality, morbidity, harm and costs. Hospitals that have joined Premier’s previous perinatal efforts have decreased maternal deaths, harm and birth trauma by more than 20 percent; improved early elective deliveries by 67 percent; and decreased medical malpractice claims by 39 percent.”
In connection with the announcement, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed Deb Kilday, principal in the women’s and children’s health service line at Premier, regarding the initiative, and its implications for innovations in maternal and children’s health. Kilday will be leading the work of the initiative on the Premier side. Below are excerpts from that interview.
Tell me about your role at Premier?
I lead the women’s and Infants’ service line here. I’ve been at Premier for seven years and have helped to develop a very structured platform that targets methodologies, tools, resources, and solutions, to help our providers to improve outcomes. We work with a number of associations and other partner groups.
We have taken a little bit of a different spin in how we can help hospitals to develop a robust data platform that pulls outcomes data in this area directly from the hospitals, in a standard, reliable format. It’s pulled from all the hospitals and risk-adjusted in a proven, standardized way, so that hospital leaders can benchmark the data. And we’ve scaled that up to 1,300 hospitals. It’s the first time many hospitals are seeing their data, and I would guess that there hasn’t been as much of a push to analyze data in this area. They can look at their coding, documentation, outcomes. And in perinatal, we have an even more robust set of data for them to look through in their dashboard. And we look at their outcomes and provide them with a roadmap, a report, showing where they’re doing well and where they can improve. We add to that an assessment of their culture of safety. And we help them measure what they’ve implemented, and provide a crosswalk as to how they can improve their outcomes.
And what is involved in the process of assessing the culture of safety in a patient care organization?
When working with individual hospitals, we do an onsite assessment involving complete interviews with their entire perinatal team; at the same time, we provide an anonymous survey of every member of the team. We use a validated survey to look at team members’ perception of safety.
As a result of this work and our collaboration at the national level, HHS became aware of some of the work we were doing. We also in April 2019 launched the “Bundle of Joy Campaign” [“focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices”]. The Bundle of Joy campaign was really Premier’s statement saying that we’re committed to identifying through current platforms or collaboration and innovation around delivering the very best care for mothers and babies. And one of the things we did is that we have the Premier Healthcare Research Database, which has over a decade of de-identified information, with data from hospitals across the U.S. We were able to identify issues at the time of delivery, including around morbidity and mortality. We knew that identifying where the opportunities are would be a new and useful way to help them guide where they need to put their resources and focus. That was the first standardized inpatient maternal and child health analysis of its type.
With a sole-source contract based on market analysis, we were the only organization with the scope and breadth to really develop this. There are a lot of programs out there around maternal and child health, but none have the scope and breadth of ours. We can use our unique research database, but also, what are hospitals doing? We have 1,300 hospitals using our quality adviser database, so that we can drill all the way down to the provider, patient, and resource level to analyze data. So we combine the database with the process roadmap, and combine that with an implementation guide measuring their implementations.
With that, we’re providing a very genuine resource. And we can partner hospitals doing really well with another hospitals across the country that’s really struggling. So we do augment and align, and that augmentation and alignment encompasses standardized elements, and utilize those along with other evidence-based tools and resources in a way that they can’t do elsewhere. We provide focused support in our collaboratives.
What are the areas that most need improvement in maternal and child health?
Why HHS was interested in doing this, is that there’s a lot of data out there, but none of it was standardized. So we don’t know yet; the data out there is not reliable. So the whole purpose of this initiative is to truly identify what is truly driving our opportunity. We need the data to drive assessments and decision-making. We don’t yet have a national picture of what this looks like at all. The goal is to identify where opportunities are, and we want to provide measurement tools to see where hospitals are and where they can improve. And you know, the United States has taken a hit, because we’re being portrayed as having mortality and morbidity rates that are too high, but we don’t really know whether our rates are that high or not. And that’s why we’ve formed this partnership; we have the tools and solutions that the government would like to have. And we’re going to prove that it works.
How should hospital senior leaders think about what you’re doing
The best way to look at it is, looking your standardized approach to maternal and child health, it really comes down to the visceral level. Leaders of organizations are the foundation for driving change. So this initiative includes the continuum from across the hospital, the interdisciplinary team. They take a look at what needs to happen. And very few organizations have looked at change in a comprehensive way. They need to look at their practices and processes in a very measured, standardized way. For example, if I’m feeding data to a collaborative—some states are doing a good job of using data, but how the hospitals collect the data varies tremendously. Some of it may come from manual chart review. So a state gets data from a lot of different areas, and they don’t have a way of risk-adjusting and evaluating the data. We work very closely with hospitals around exactly how they put the data in, and how they analyze. There needs to be an alignment of efforts.
What is the timeframe for this initiative?
The recruitment of at least 200 hospitals, using very structured criteria to help hospitals get involved, will begin now almost immediately, with the publication of this announcement. Premier will recruit hospitals into this initiative; they don’t have to be Premier members. We’re looking at hospitals with disparities around the social determinants of health, in particular. We’re looking at all disparities and social determinants. We’re trying to determine what is driving outcomes for all women. We have the support of MoMMA's Voices, which is a coalition of about 17 different organizations that represent the voice of the patient and family. We’ve included that as part of this project, because we’re going to be focused on the voices of all women across the country. Native American populations, Hispanic, racial and ethnic diversity; and we’re going to be look at different payer populations. We’ll be able to pull in many of the social determinants of health around economics; age will be an important element to look at. And the other attribute that’s really important to mention is that this is about the mother-infant dyad. What can we do to identify women at risk when they come into the hospital? What happens when they go home? What drives readmissions? And we’re going to be looking at de-identified data on both mothers and babies. So, what is the actual impact of substance abuse on that, for example?
Do you have any additional thoughts on the initiative?
I think excitement around this pretty huge. We know the Office of Women’s Health has been looking to drive some of these opportunities across the continuum. I think the opportunity for the information that this partnership with HHS will provide to the nation, will be unparalleled. There are going to be elements we don’t even know yet, but there are so many. It’s just an incredible project that we are so honored to be a part of, and know that this is truly going to help us as a nation to improve the lives and health of mothers and babies.
