OHCA Cesarean Section Quality Initiative

Low-risk cesarean deliveries (LRCD) have continued to increase in the United States, with increases for each race and Hispanic-origin group. Per CDC statistics, the LRCD rate increased to 25.9% in 2020, from 25.6% in 2019 — a 1% increase for all races and origins. In this same time period, LRCD rates increased 2% in for non-Hispanic black birthing persons (30.0% to 30.6%) and 1% for Hispanic (24.8% to 25.1%) and non-Hispanic white birthing persons (24.7% to 24.9%).

Cesarean deliveries are considered low risk when they are nulliparous (first birth), term (37 or more completed weeks), singleton (one fetus), and cephalic (headfirst). For low-risk pregnancies, cesarean delivery can pose a greater risk of maternal and infant morbidity and mortality than vaginal delivery. Due to the known risks of LRCD, the U.S. Department of Health and Human Services set a Healthy People 2030 goal of 23.6 percent for the LRCD rate.

Because SoonerCare covers more than 50% of all births in the Oklahoma, reducing the number of LRCD births is an opportunity for OHCA to improve the quality of maternal and infant health, reduce overall maternal morbidity and mortality, and address disparities in health care.

Goal:

 Reduction of primary cesarean sections without medical indication.

Methodology:

Beginning in January 2011, every contracted hospital and physician that performs a minimum of 25 SoonerCare deliveries during a SFY receives a letter with their primary C-section rate and total C-section rate. The rates are computed as follows:

• Primary C-Section Rate = Primary C-sections divided by the sum of primary c-sections + vaginal deliveries
• Total C-Section Rate = All C-sections divided by all deliveries
• Exclusions = Assistant surgeons and VBACs

Claim Submission Instruction:

• Cesarean Section Quality Initiative Instructions
• Claim Submission with Medical Record Attachments
• C-Section Questions and Answers