August 13, 2014
OHCA Contacts: Jo Kilgore - (405) 522-7474, Jennie Melendez - (405) 522-7404
Delivers on Reducing Costly C-section Rates among Oklahoma’s Medicaid
CITY – A program that aims to reduce the number of medically unnecessary
Cesarean Sections (C-sections) among women enrolled in SoonerCare (Oklahoma
Medicaid) is delivering promising results. An independent evaluation of the
Oklahoma Cesarean Section Quality Initiative documents a statistically significant decrease in medically unnecessary
C-sections from 1.81 percent to 1.43 percent.1 The evaluation also shows $1.2 million in cost
savings to the SoonerCare program over the two-year study period. The
assessment by The Lewin Group (www.lewin.com) is on behalf of the
Oklahoma Health Care Authority (OHCA), creator and implementer of the initiative.
Oklahoma has a relatively
high C-section rate. According to the Centers for Disease Control and
Prevention (CDC), the Sooner state ranked 14th nationally in 2011 with a
C-section rate of 34.2 percent. This is a major concern for the SoonerCare
program, which is the primary payer for more than 60 percent of pregnant women
in the state. C-sections carry risks of complications for both mother and baby,
so addressing medically unnecessary C-sections is not only a cost-saving issue
but a potentially lifesaving one.
The Lewin report
shows a number of substantial findings about the success of the OHCA C-section
Quality Initiative. The evaluation validates that the southwest area of the
state experienced a statistically significant
decrease in the medically unnecessary C-section rate2 (2.16 percent
to 1.28 percent), as well as Oklahoma’s American Indian population, which
decreased from 2 percent to 1.14 percent.
A look at state
fiscal years (SFY) 2012 and SFY 2013 shows a total of 212 C-sections deemed medically
unnecessary by OHCA.
In addition, primary
C-section rates3 are down. Lewin reports a significant decrease in
the primary C-section rate among SoonerCare mothers during the initiative
period, from 19.75 percent to 17.83 percent among hospital claims and from
21.43 percent to 20.03 percent among physician claims.
When reviewing charts
for medical necessity, OHCA only reviewed hospital claims for providers who had
a primary C-section rate of over 18% percent in SFY 2011. The C-section Quality
Initiative was evaluated for effectiveness and quality from July 1, 2010
through June 30, 2013.
According to the CDC,
in 2012 the national C-section delivery rate was 32.8 percent - a rate that
rose nearly 60 percent from 1996 to 2009.
Reducing the number of C-sections without medical necessity, as well as
induction of labor prior to 39 weeks, is included in the Healthy People 2020 agenda (the federal plan for improving
the health of Americans).
evaluation of the Oklahoma Cesarean Section Quality Initiative can be found on
the OHCA website at http://www.okhca.org/cs-report.
For those providers
whose operative deliveries were reviewed, approximately 30 percent of
The rate of medically
unnecessary C-sections is calculated as the number of claims deemed medically
unnecessary divided by the number of claims that were reviewed.
The primary C-section
rates in the OHCA initiative and this evaluation reflect first births by
SoonerCare mothers for which a C-section was performed, as a percentage of (all
vaginal and primary C-section) births among SoonerCare mothers.
About the Oklahoma Cesarean Section Quality Initiative
In an effort to
decrease the number of medically unnecessary C-sections in the state, OHCA
implemented the C-Section Quality Initiative in 2011. The purpose of the initiative was to decrease
the primary C-section rate to 18 percent or less by ensuring providers and
hospitals were using best practices in performing C-sections with enrollees in
the SoonerCare Program.
Oklahoma’s Medicaid program, known as
SoonerCare, is administered by the Oklahoma Health Care Authority (OHCA).
SoonerCare works to improve the health outcomes of Oklahomans by ensuring that
medically necessary benefits and services are responsive to the health care
needs of our members. Qualifying Oklahomans include certain low-income
children, seniors, the disabled, those being treated for breast or cervical
cancer and those seeking family planning services. Insure Oklahoma assists
qualifying adults and small business employees in obtaining health care
coverage for themselves and their families. OHCA strives to educate and engage
our current 808,438 members
regarding personal responsibilities for their health services utilization,
behaviors, and outcomes in partnership with a state-wide network of 38,879 providers.
For more information, visit www.okhca.org.