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Designing a Provider Incentive System to Increase Adherence to Maternity
To increase the number of obstetrical providers who adhere to the 5 A’s tobacco cessation guidelines when treating pregnant smokers in Oregon, investigators developed a comprehensive reimbursement system that incentivizes obstetrical providers to consistently deliver tobacco cessation advice to pregnant smokers. They also developed an implementation strategy for this reimbursement system and established collaborative relationships with Oregon entities engaged in maternity tobacco cessation. Investigators first established a collaborative planning team and designing and conducting interviews with MCO administrators to identify potential barriers to adoption by health plans. Using this information, they developed a reimbursement system and a billing mechanism based on delivery of added tobacco cessation services during pregnancy. They then created a financial model, which estimated that Providence Health Plan would realize a net benefit of approximately $350,000 annually through reducing the number of smoking-related low birth weight babies. In addition, investigators created explanatory materials to introduce the reimbursement system to providers and their office staff. While the coding and reimbursement guideline has been disseminated to many interested health plans, the Oregon Medicaid program (Oregon Medical Assistance Program, or OMAP) is only health plan to have adopted the provider reimbursement program to date. This suggests that a provider reimbursement incentive would need to be adopted simultaneously across all health plans in a given locality, in order to help neutralize the market pressures causing plans to compete for the lowest possible premiums. For more information, contact: Charles J. Bentz, MD, FACP
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