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Smart Care California Announces Third Annual C-Section Honor Roll

Over half of the hospitals that offer maternity services in the state made the list

Sacramento – Smart Care California, a coalition of public and private health care purchasers that collectively purchase or manage care for more than 16 million people statewide, released the third annual C-Section Honor Roll. The Honor Roll recognizes 122 hospitals that met or surpassed a federal target aimed at reducing births via Cesarean section (C-section) in first-time mothers with low-risk pregnancies.

View the complete list of hospitals.

The U.S. Department of Health and Human Services adopted the Healthy People 2020 target of reducing nationwide C-section rates for low-risk, first-births to 23.9 percent, in part to respond to a rapid rise in medically unnecessary C-sections across the United States.

The California Health and Human Services Agency (CHHS) announced the awards, which reflect 2017 hospital discharge and birth certificate data from 240 California hospitals that offer maternity services. The 122 hospitals represent more than half of all hospitals that offer maternity services in California. By comparison, 111 hospitals made the 2017 Honor Roll.

“I congratulate these hospitals and providers for their work in reducing medically unnecessary C-sections,” said Michael Wilkening, CHHS Secretary. “The data shows that we are heading in the right direction, but we have more work to do.”

Evidence suggests that the chance of having a C-section delivery largely depends on aspects such as where a woman delivers and the practice patterns of her obstetric care team. Even for low-risk, first-birth pregnancies, huge variations are noted in rates of C-sections at individual hospitals. In California hospitals, these rates range from less than 15 percent to more than 70 percent.

Overuse of C-sections matters. For mothers, it can result in higher rates of complications like hemorrhage, transfusions, infection, and blood clots. Once a mother has had a C-section, she has a greater than 90 percent chance of having one again for subsequent births, leading to higher risks of additional major complications. The surgery also brings risks for babies, including higher rates of infection, respiratory complications, and neonatal intensive care unit stays.

Of the 122 hospitals being recognized this year, 71 have achieved Honor Roll status three years in a row.

“The increasing number of hospitals making the Honor Roll shows that collaborative action can lead to positive change,” said Elliott Main, MD, medical director for the California Maternal Quality Care Collaborative (CMQCC), which is leading a quality-improvement collaborative to promote vaginal birth in more than 100 California hospitals. “Thanks to the efforts of key stakeholders, we’ve been able to enhance data transparency, create a toolkit for obstetric providers, form hospital quality improvement collaboratives, engage purchasers and health plans, and much more.”

Health care purchasers are working with health plans to narrow variation around the national performance target for C-sections for low-risk, first time pregnancies. Hospitals that submit data to the CMQCC Maternal Data Center and participate in CMQCC sponsored collaboratives to adopt best practices are progressively moving toward that target.

“Purchasers understand that variation starts with us if we each ask the delivery system to focus on different improvement targets,” said Lance Lang, MD, Chief Medical Officer at Covered California. “Through Smart Care California, the three state purchasers and the Pacific Business Group on Health have together made improving maternity care a priority and the results of the latest honor roll reflect how the delivery system has responded and we are delighted.”

To further address the problem, earlier this year the California Health Care Foundation, in partnership with CMQCC and Consumer Reports, launched My Birth Matters, a statewide educational campaign aimed at informing expectant mothers about the overuse of C-sections and encouraging meaningful conversations between patients and their care team.

View the full list of hospitals receiving this award

View the latest quality data for all California hospitals

Learn more about reducing low-risk, first birth C-sections

About Smart Care California
Smart Care California is a public-private partnership working to promote safe, affordable health care in California. The group currently focuses on three issues: Csections, opioids and low back pain. Collectively, Smart Care California participants purchase or manage care for more than 16 million Californians—or 40 percent of the state. Smart Care California is co-chaired by the state’s leading health care purchasers: the Department of Health Care Services, which administers Medi-Cal; Covered California, the state’s health insurance marketplace; and CalPERS, which manages pension and health benefits for California’s public employees, retirees, and their families. IHA convenes and coordinates the partnership with funding from the California Health Care Foundation. Learn more about Smart Care California.