News Release

August 13, 2014

OHCA Contacts: Jo Kilgore - (405) 522-7474, Jennie Melendez - (405) 522-7404 

OHCA Initiative Delivers on Reducing Costly C-section Rates among Oklahoma’s Medicaid Population 

OKLAHOMA 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 ( 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). 

The complete evaluation of the Oklahoma Cesarean Section Quality Initiative can be found on the OHCA website at 

1.    For those providers whose operative deliveries were reviewed, approximately 30 percent of obstetricians. 

2.    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. 

3.    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