California Health and Human Services Secretary Diana S. Dooley held a press briefing recently to recognize 104 hospitals (PDF) that have met or surpassed a federal goal aimed at reducing low-risk, first-time cesarean deliveries, commonly referred to as c-sections. She announced these achievement awards on behalf of Smart Care California, a coalition of public and private health care purchasers that cover nearly half of all Californians. This recognition represents a major milestone in the movement to reduce unnecessary c-sections in California. It’s important because it reflects how far the state has come to build consensus for reducing unnecessary c-sections and to do the hard work needed to drive continued improvement. Here is the condensed text of Secretary Dooley’s remarks:

Smart Care California, a new public-private partnership that promotes safe and accessible health care for all Californians, is cochaired by the California Department of Health Care Services, Covered California, and CalPERS. What makes this group so unique is our collective purchasing power; together, the groups leading and participating in Smart Care California purchase or manage health care for 16 million Californians. That’s 40% of the covered lives in California.

What makes care smart? In many cases, it does not always mean providing more care. Often, more heath care does more harm than good to patients. It also wastes resources that might be better spent elsewhere. One area where care absolutely needs to get smarter is maternity care, specifically addressing the problem of unnecessary c-sections. Maternity care is a big deal, especially here in California. Every year we deliver half a million babies in this state.

In recent years, we’ve seen a disturbing trend. In 1997, one out of every five births in California was by c-section. Last year, it was one in three. Research tells us that it’s not medically necessary for one-third of babies to be born by abdominal surgery.

It is true that in some circumstances, c-sections are absolutely crucial. But every time a hospital performs a c-section unnecessarily, it puts the mom and the baby at unnecessary risk. For moms, this means higher rates of hemorrhage, transfusions, infection, and blood clots. For babies, this means higher rates of infection, respiratory complications, and neonatal intensive care unit stays.

C-sections also cost, on average, 50% more than vaginal deliveries.

A few years ago, the US Department of Health and Human Services took a close look at this problem to determine what a reasonable and responsible c-section rate should be. They established 23.9% as a national goal for low-risk, first-birth c-sections. And they made it one of their Healthy People 2020 goals.

That brings us to this moment. We are publicly recognizing the 104 hospitals (PDF) in our state that have reached or surpassed this Healthy People 2020 goal for low-risk, first-birth c-sections. By preventing thousands of unnecessary c-sections each year, these hospitals are delivering safer and more affordable care for Californians.

In future years, we would love to be able to give this award to all 244 maternity hospitals in California. Meeting or beating the goal of 23.9% is something every hospital care team can and should do.

Hospitals now have more tools and more opportunities than ever to improve. For example, with funding from the California Health Care Foundation, the California Maternal Quality Care Collaborative (CMQCC) has developed a free toolkit to help providers promote vaginal birth and reduce unnecessary c-section rates for low-risk, first-birth deliveries. CMQCC is also offering hands-on training and mentoring to hospitals and their care teams. I am pleased to report that as of early 2017, about 90 California hospitals will be engaged in this collaborative work to lower their rates of unnecessary c-sections.

In addition to the resources available to hospitals, Covered California recently announced that, under its new contract, insurers on its exchange would require that contracted providers meet standards on a number of quality measures, including c-section rates. This is very much a team effort.

Diana Dooley

Diana Dooley was appointed secretary of the California Health and Human Services Agency in December 2010 by Governor Jerry Brown. She leads 13 state departments within the agency, chairs Covered California (the Health Benefit Exchange), and serves as chair or member of numerous other boards and commissions. Previously, Dooley was president and CEO of the California Children’s Hospital Association.

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