& PROUDLY PRESENT COIN Collaborative Surveillance, QI and - PowerPoint PPT Presentation

& PROUDLY PRESENT COIN Collaborative Surveillance, QI and Billing January 31, 2014 Jonathan Goldfinger, MD, MPH, FAAP Director, AltaMed Lactation Clinic Skirball Fellow, Division of General Pediatrics Children’s Hospital Los Angeles

By 3 months Orange County exclusive rates drop to ~35% Note by 3 months LA’s exclusive BF rates drop to ~25-30%

Note the same drop in exclusive BF rates at AltaMed’s 2 largest pediatric clinics in LA Also note the large volumes (N) found in singe-clinic EMR data

Note the same drop in exclusive BF rates (green) on the corporate level

Reasons Mothers Stop: LA County WIC Survey Mom felt she did not have enough milk 53.9% Breast milk alone did not satisfy the baby 48.1% The baby had difficulty nursing 35.9% 26.6% Nipples were sore, cracked or bleeding It was the right time to stop 24.9% Mom or baby became sick and couldn’t 20.7% breastfeed Mom returned to work 16.4% Mom felt that baby was not gaining 15.4% enough weight Mom was encouraged by someone 6.9% to stop breastfeeding Courtesy of Breastfeeding Practices of WIC Participants, The 2005 Los Angeles County WIC Survey: The Second in a Series of Reports (July, 2005)

AAP and CDPH/CDC grants funded our interdisciplinary breastfeeding support program We address both mother and newborn health and well-being • safe hospital-to-home transitions, care coordination • latch issues, dysphagia, laryngomalacia, ankyloglossia • excessive newborn weight loss, hyperbilirubinemia • congenital heart disease, chronic lung disease, prematurity • insufficient milk supply, engorgement, fungal infections, mastitis • post-partum depression, medical contraindications, return to work Key partners: CHLA’s UCEDD, PHFE WIC, Hollywood Presbyterian Medical Center, LA County’s Department of Public Health, BreastfeedLA, local pediatricians and IBCLC’s, and of course, AltaMed Health Services Corporation

SPECIAL THANKS TO THE COIN COLLABORATIVE! • We now measure breastfeeding data utilizing the NextGen EMR • Greater than 95% of Lactation Clinic babies are breastfed, and their mother are reaching their personal goals! • 53% of Lactation Clinic babies are breastfeeding exclusively through 9 months , compared to 21% of GPS-alone babies and 14% of babies AltaMed-wide! • Elated families offer to support the Lactation Clinic, AltaMed and CHLA • We are successfully billing all insurance types ensuring our sustainability

COIN Breastfeeding Surveillance Interpretation: Lactation Clinic mothers are 2 times more likely to exclusively breastfeed past 6 months per recommendations than mothers seen by physicians only at the AltaMed General Pediatrics Clinic at CHLA and over 3 times more likely than mothers seen by physicians only at all AltaMed Clinics.

Exclusive BF Rates 2-4 month olds 60% 26% 27% 32% 21% 22% 23% 22%

Exclusive BF Rates 2-4 month olds 26% 21% 24% 24%

ABM Breastfeeding-Friendly Physician’s Office Protocol Reviewed with AltaMed Admin During Grant Revised 2013 #1 Establish a written breastfeeding-friendly office policy. #2 Offer culturally and ethnically competent care. #3 If providing antenatal care, introduce infant feeding in the first trimester and support breastfeeding throughout the pregnancy. If providing postnatal care for the infant, offer a prenatal visit during which your commitment to breastfeeding can be shown. #4 Support Baby-Friendly

ABM Breastfeeding-Friendly Physician’s Office Protocol Reviewed with AltaMed Admin During Grant Revised 2013 #5 Encourage breastfeeding mothers to avoid formula, glucose water, or other liquids unless medically indicated. Advise not to offer bottle or a pacifier until breastfeeding is well established. #6 Schedule a first infant follow-up visit 48 – 72 hours after hospital discharge or earlier if breastfeeding-related problems, such as excessive weight loss ( >7%) or jaundice are present at hospital discharge. Ensure access to a lactation consultant/educator or other healthcare professional trained to address breastfeeding questions or concerns during this visit. #7 Ensure availability of educational resources for parents. #8 Allow and encourage breastfeeding in the waiting room.

ABM Breastfeeding-Friendly Physician’s Office Protocol Reviewed with AltaMed Admin During Grant Revised 2013 #9 Ensure the office environment demonstrates breastfeeding promotion and support. Eliminate free formula and items from formula companies. #10 Develop and follow telephone triage protocols to address breastfeeding concerns and problems. #11 Commend breastfeeding mothers during each visit for choosing and continuing breastfeeding. #12 Encourage mothers to exclusively breastfeed for 6 months and to continue breastfeeding with complementary foods until at least 24 months and thereafter as long as mutually desired. #13 Set an example. Have a written breastfeeding employee policy and a lactation room with supplies for employees who breastfeed or express milk at work.

ABM Breastfeeding-Friendly Physician’s Office Protocol Reviewed with AltaMed Admin During Grant Revised 2013 #14 Acquire or maintain a list of community resources and be knowledgeable about referral procedures. Refer expectant and new parents to peer, community support, and resource groups. #15 Support and advocate for health policy that incorporates the costs of breastfeeding care into routine health services. #16 Where laws exist, enforce workplace laws that support breastfeeding.

ABM Breastfeeding-Friendly Physician’s Office Protocol Reviewed with AltaMed Admin During Grant Revised 2013 #17 All clinical physicians should receive education regarding breastfeeding, beginning in the preclinical years. #18 Volunteer to let medical students and residents rotate in your practice. #19 Track breastfeeding initiation and duration rates in your practice and learn about breastfeeding rates in your community.

Payer # of Encounters % Paid Aetna 9 58% Aetna PPO 2 86% Anthem Blue Access PPO 2 100% Anthem Blue Cross PPO 15 48% Blue Cross Blue Shield PPO 4 40% Blue Cross HMO 16 19% Blue Cross MediCal 31 77% Insurance Blue Shield Of California PPO 5 44% Carefirst Health Plan MediCal 37 70% Payment Cigna HMO 10 67% Cigna PPO 4 31% Patients Seen Health Net CHDP 1 100% and Percent Paid Health Net HMO 1 0% Health Net MediCal 27 89% February 2013- Kaiser Foundation Healthplan 5 0% LA Care 4 0% January 2014 LA Care MediCal 9 67% MediCal 245 89% MediCal CHDP 14 96% MediCal CPSP 54 73% Salud Con Health Net 4 0% Self-Pay/SFS 66 0% United Health Care 2 100% United Healthcare 1 84% United Healthcare Choice Plus 13 19% Grand Total 581 75%

Percent Reimbursement Babies vs. Mommies Babies Moms # of # of Insurance Type Encounters % Paid Insurance Type Encounters % Paid 1 100% CHDP MANAGED CARE COMMERCIAL MANAGED CARE COMMERCIAL 15 42% 16 14% HMO HMO 41 71% 63 81% MANAGED MEDICAL MANAGED MEDICAL 208 91% 105 78% MEDICAL MEDICAL OTHER PAYERS 4 100% OTHER PAYERS 7 80% 1 0% 4 0% PRIVATE/COMMERCIAL HMO PRIVATE/COMMERCIAL HMO 23 44% 27 29% PRIVATE/COMMERCIAL PPO PRIVATE/COMMERCIAL PPO 17 0% 49 0% Self-Pay/SFS Self-Pay/SFS Grand Total 310 84% Grand Total 271 64%

• Comprehensive, interdisciplinary home-based care • Physicians and IBCLC’s working together for better outcomes • Reimbursement is a big concern • Technology-enabled support will be key to success • The next big thing in breastfeeding support?

To share breastfeeding resources for other moms in your community click here or visit latchMD.com/Add4moms. To view mapped resources in your community see our new map here or visit latchMD.com/map.php. To latch on today: Visit our website www.latchmd.com Email us at latchmd@gmail.com Chat with us on Google Helpouts Or like us on facebook.com/latchMD!