This is a comprehensive report describing OB services for the members. Key metrics are provided for trending; VBAC (vaginal birth after C-section), Vaginal, C-Section Deliveries, Pregnancies in Progress, Terminations, Ultrasound Volume, and others are provided in the header in addition to the average cost metrics. The panels provide tables and graphs where data lines can be selected and information is filtered to provide additional detail and granularity to the analysis.
Target Audience for this Report
Chief Medical Officer, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Physician Relations, Quality Management, and Utilization Management.
Business Processes Impacted by this Report
Identification of high-risk pregnancy and pregnancy gaps in care with the maternity data can engage case managers with members to manage or reduce the risk of premature delivery or complications.
Comparisons of maternity costs across facilities and providers informs the network development, medical management, and finance department regarding variances and opportunities for cost reductions through provider education and member engagement.
Best practices can be identified in the data and referral patterns can be modified to support a high performing network using the maternity metrics.
This report is designed to provide clarity on provider performance for OB/delivery cases, with a goal of improving operational performance. Because the report provides peer comparison data, the goal should be to improve the performance of lower rated or higher cost providers by benchmarking against higher rated performers in each category.
This is a higher level look at OB provider performance in delivery cases, with the ability to see detail on deliveries with complications and associated costs.
Detail and Definitions
Cesarean deliveries are identified by a subset of CPT codes associated with member/patient records; See Appendix B.
C-section rate is (the total cesarean section rate) is calculated as the number of births delivered by cesarean section divided by the total number of deliveries.
Complications – refer to either co-morbid conditions that complicate a pregnancy, or conditions related to the pregnancy or delivery that occur, complicating the pregnancy and/or delivery. The “Complication Type” and “Complication Detail” in this report provide granularity as to the specific complication.
Direct Costs is the amount paid to the provider(s) within the selection criteria.
Indirect Costs are costs other than Direct Costs paid within the selection criteria.
Members with OB services consists of records for every member/patient that had a procedure or diagnosis code (associated with this report) on a claim, during the reporting period. All procedure and diagnosis codes used in the creation of this report are available for review.
Pregnancy in Progress records are identified by a subset of CPT codes associated with member/patient records; See Appendix B.
Puerperium - the period of about six weeks after childbirth during which the mother's reproductive organs return to their original non-pregnant condition.
Terminations are designated by a subset of CPT codes associated with member/patient records; See Appendix B.
Total Costs – is the total of Direct Costs and Indirect Costs for the selection criteria.
Ultrasound rate is calculated as the average number of ultrasounds performed per delivery.
Vaginal deliveries are designated by a subset of CPT codes associated with member/patient records; See Appendix B.
VBAC – Vaginal birth after previous Cesarean delivery.
VBAC records are identified by a subset of CPT codes associated with member/patient records; See Appendix B.
Report Details and Navigation
OB Types (Complication vs Non-Complications) Graph
- Delivery Cesarean
- Delivery Vaginal
- Delivery VBAC
- Postpartum Care
- Provider Name
- Direct Costs
- Indirect Costs
- CSec %
- % Compl
Complication Type Graph
- Complication Type
- Total Cost
Pregnancy w/Complications Diagnosis
- Total Paid
Patients with OB Status
- Member Number
- Member Name
- Preg Complication
- Total Cost
- US (Ultrasounds)
The bar chart on the top left (titled “Total Paid by Delivery Type), is driven by a combination of procedure (CPT) and diagnoses (ICD 9) codes, and contains the following delivery type/state categories; Vaginal Delivery, Cesarean Delivery, Pregnancy in Progress, and VBAC. The two bar colors, green and red, signify Uncomplicated Pregnancy and Pregnancy with Complications respectively. Initial focus on loading (or refreshing) this screen is on “Vaginal deliveries” with complications. The user may select a complication type (bar) in this graph to drive the detail in subsequent quadrants. The table of CPT and ICD codes used in this report is available in Appendix B.
Uncomplicated pregnancy is indicated by the presence of an associated diagnosis code on a member/patient record, and Pregnancy with Complications is likewise indicated by the presence of an associated diagnosis code on a member/patient record.
The second chart on left side of the page is titled “Complication Type”. This chart will only be populated if a red, “Pregnancy with Complications” section is selected in the first bar chart. Content here is driven by the selection of “Delivery Type/Pregnancy with Complications” (red section) in the first bar chart. Complication type is determined by ICD 9 codes. When any one of the “Delivery Types” of Vaginal Delivery, Cesarean Delivery, Termination or VBAC, is selected in combination with “Pregnancy with Complications” the Complication Types will include “Complications mainly related to pregnancy”, “Other complications affecting pregnancy”, and “Complications occurring mainly in the course of labor and delivery”.
The “OB Providers” table, is populated with the associated servicing provider (and taxonomy) of the members in the filtered criteria, based on claims in the 12-month reporting period. The columns in this table are “Provider Name”, “Specialty” (from the NPI database), “Patients” (number of patients in the filtered set), “Direct $/Patient” (to the provider), “Indirect $/Patient” (all other costs), “$/Patient” (total cost/patient) “CSec %” (percentage of total OB cases for that provider that are C-sections), “% Compl” (percentage of total OB cases for that provider with complications), and “Ultrasound/Case” (average number of ultrasounds per OB case for that provider).
The table “Patients with OB Cases” lists the patients with OB cases (within the selected criteria). Fields in this table include “Member Number”, “Member Name”, “Age” (current), “Delivery” (delivery type), “Preg Complications” (Yes/No flag), “Total Cost”, and “US” (number of ultrasounds). There is hotlink on member name that will navigate to the Maternity calendar for that member.