Foundation Program Sites

Obstetrics and Reproductive Health

Read our Recommendations

(Adopted July 2012)

Cesarean sections (C-sections) show wide variation and overuse nationally and also in Washington State. This workgroup met from December 2011 to July 2012 to recommend eliminate all elective deliveries before the 39th week of pregnancy (for which there is no appropriate documentation of medical necessity), decrease elective inductions of labor between 39 and up to 41 weeks, and decrease unsupported variation among Washington hospitals in the C-section rate for women who have never had a C-section.

Supporting Materials

Letter from Health Care Authority Accepting Obstetrics Care Report

Workgroup Members

Member Title Organization
Theresa Helle Manager, Health Care Quality & Efficiency Initiatives The Boeing Company
Ellen Kauffman, MD OB-COAP Medical Director Foundation for Health Care Quality
Robert Mecklenburg, MD Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Carl Olden, MD (Chair) Family Physician Pacific Crest Family Medicine, Yakima
Mary Kay O’Neill, MD, MBA Executive Medical Director Regence Blue Shield
Dale Reisner, MD Obstetrician/Gynecologist Swedish Hospital Perinatologist
Terry Rogers, MD Chief Executive Officer Foundation for Health Care Quality
Roger Rowles, MD Obstetrician/Gynecologist Yakima Memorial OB-GYN

Read our Bundled Payment Model

(Adopted May 2021)

The United States has a high maternal mortality rate with high racial disparities. Bundled payment models, one payment for multiple clinical services such as for obstetrics and pediatric care, are being used to address preventable complications and increase coordination of care. Our workgroup met through 2019 and reconvened in 2020 to develop clinical pathways for prenatal care, labor and delivery, postpartum care, and pediatric care supported by a bundled reimbursement model to improve the care delivery and therefore outcomes. Our fist iteration was finalized in 2020 and pediatric care added in 2021.

Meeting Materials

Date Materials
October 27 Agenda October 27
Minutes September 22
Draft Maternity Bundle w/ Peds
September 22 Agenda 09/22/20
Minutes 08/25/20
Draft Maternity Bundle w/ Peds
August 25 Agenda 08/25/20
Minutes 07/28/20
Draft Maternity Bundle w/ Peds
July 28 Agenda 07/28/20
Maternity Bundle Final
Newborn Care Bree Proposal
Perinatal Bundle Review
January 7 Agenda 01/07/20
Minutes 10/10/19
Draft Maternity Bundle
Minutes 01/07/20
October 10 Agenda October 10
Minutes September 12
Draft Maternity Bundle
ACOG Postpartum Care Plan
September 12  Agenda September 12
Minutes August 8
Draft Maternity Bundle
August 8 Agenda August 8
Minutes July 11
Draft Maternity Bundle
July 11 Agenda July 11
Minutes July 9
Draft Maternity Bundle
June 6 Agenda June 6
Minutes May 9
Draft Maternity Bundle
May 9 Agenda May 9
Minutes April 11
Draft Maternity Bundle
Literature Review
ACOG Optimizing Post Partum Care
April 11 Agenda April 11
Draft Minutes March 14
March 14 Agenda March 14
Draft Minutes February 14
HCP LAN Establishing Maternity Episode Payment Models
February 14 Agenda February 14
Minutes January 8
HCP LAN White Paper Maternity Bundle
January 8 Agenda January 8
Presentation Slides
Maternity Bundle Charter and Roster
Bree Process Infographic
HCP-LAN Maternity Clinical Episode Payment Model
AJMC Bundled Payments for Maternity Care
Conflict of Interest Form
OPMA Training Roster

Workgroup Members

Member Title Organization
Carl Olden, MD (Chair) Family Physician  Pacific Crest Family Medicine
Andrew Castrodale, MD Family Physician Coulee Medical Center
Angela Chien, MD Obstetrics and Gynecology EvergreenHealth
Neva Gerke, LM President Midwives Association of Washington
Molly Firth, MPH Patient Advocate
Lisa Humes-Schulz, MPA/
Lisa Pepperdine, MD
Director of Strategic Initiatives/ Director of Clinical Services Planned Parenthood of the Great Northwest and Hawaiian Islands
Rita Hsu, MD, FACOG Obstetrics and Gynecology Confluence Health
Dale Reisner, MD Obstetrics and Gynecology Swedish Medical Center
Janine Reisinger, MPH Director, Maternal-Infant Health Initiatives Washington State Hospital Association
Mark Schemmel, MD Obstetrics and Gynecology Spokane Obstetrics and Gynecology, Providence Health and Services
Vivienne Souter, MD Research Director Obstetrics Clinical Outcomes Assessment Program
Judy Zerzan, MD Chief Medical Officer Washington State Health Care Authority

Read our Guidelines

(Adopted November 2020)

Minority populations are disproportionately effected by unintended pregnancy, sexually transmitted diseases, and have lower rates of screening for common cancers. Access to high-quality care also varies. This workgroup developed evidence-based recommendations on culturally sensitive mechanisms to improve the standard of reproductive and sexual health care especially for people of color, immigrants and refugees, victims and survivors of violence, and people with disabilities. The workgroup met from January to November 2020.

See the Charter and Roster

Meeting Materials

Date Materials
January 8 Agenda January 8
Bree Intro Slides
Bree Process
Charter Roster Draft January 8
February 5 Agenda February 5
Minutes January 8
Charter Roster Draft

CLAS Standards
Healthy People 2020
March 4 Agenda March 4
Minutes February 5
Guideline and Systematic Review Search Result
OPRHAC Tool
Immigrant Women’s Access… to Care
ACOG Health Care for Unauthorized ImmigrantsColumbia Basin Health Association Presentation
April 1 Agenda April 1
Minutes March 4
Draft Recommendations
ACOG 2015 Racial Disparities
Black Mamas Matter Toolkit
May 6 Agenda May 6
Minutes April 1
Draft Recommendations
June 3 Agenda June 3
Minutes May 6
Draft Recommendations
CUES Intervention Graphic
July 1 Agenda July 1
Minutes June 3
Draft Recommendation
August 5 Agenda August 5
Minutes July 1
Draft Recommendations
Neighborcare Health Service Commitments
September 2 Agenda September 2
Minutes August 5
Draft Recommendations
October 29 Agenda October 29
Minutes September 2
Draft Recommendations
Public Comments

Workgroup Members

Name Title Organization
Charissa Fotinos, MD (Chair) Deputy Chief Medical Officer Washington State Health Care Authority
Trish Anderson, MBA Senior Director, Safety and Quality Washington State Hospital Association
Janet Cady, ARNP Medical Director, School Based Program Neighborcare
Angela Chien, MD Obstetrics and Gynecology EvergreenHealth
Paul Dillon/Lili Navarrete Latinx Outreach & Organizing Program Planned Parenthood of Greater Washington and North Idaho
Colin D. Fields, MD Chief, Gender Health Program Kaiser Permanente Washington
Leo Gaeta Vice President of Programs
The Columbia Basin Health Association
Cynthia Harris, PhD Family Planning Program Manager Department of Health
Leigh Hofheimer Program Coordinator Washington State Coalition Against Domestic Violence
Rita Hsu, MD, FACOG Obstetrics and Gynecology Confluence Health
Heather Maisen, MPH, MSW Family Planning Program Manager Public Health – Seattle & King County
Adrianne Moore Deputy Director of Quality Improvement Upstream
Ivanova Smith Patient Advocate UW LEND Faculty
Mandy Weeks-Green Senior Health Policy Analyst Officer of the Insurance Commissioner
Catherine West, JD Staff Attorney Legal Voice (formerly Northwest Women’s Law Center)
Giselle Zapata-García Co-Director Latinos Promoting Good Health (also Latinx Health Board, Executive Committee Co-Chair)

Read our Guidelines

(Adopted January 2018)

Hysterectomy is one of the most commonly performed procedures in the United States, but rates are highly variable based on location. The workgroup met from March 2017 to January 2018 to develop to promote appropriate use of hysterectomy, including pre-surgical counseling and evaluation, while recognizing individual variation based on clinical opinion and patient preference with the following focus areas:

  • Assessment and medical management, by indication
  • Uterine sparing procedures, by indication
  • Surgical procedure including follow-up care, emphasizing the enhanced recovery after surgery protocol and use of a minimally invasive approach

Supporting Materials:

Letter from the Health Care Authority Accepting Hysterectomy Recommendations

Hysterectomy Charter and Roster

Workgroup Members

Name Title Organization
Pat Kulpa, MD, MBA Medical Director Regence BlueShield
Sharon Kwan, MD, MS Interventional Radiologist University of Washington Medical Center
John Lenihan, MD Medical Director of Robotics and Minimally Invasive Surgery MultiCare Health System
Jennie Mao, MD Clinical Assistant Professor, Department of Obstetrics and Gynecology University of Washington Medical Center
Rachelle McCarty, MPH Patient Advocate
Sarah Prager, MD Chair Washington State Section of ACOG
Kevin Pieper, MD Chief, Women’s and Children’s Providence Regional Medical Center Everett
Kristin Riley, MD, FACOG Assistant Professor, Department of Obstetrics and Gynecology University of Washington Medical Center
Jeanne Rupert, DO, PhD (Chair)  Family Physician One Medical
Anita Showalter, DO, FACOOG Associate Professor and Chair, Women’s Health Pacific Northwest University of Health Sciences
Susan Warwick, MD Obstetrics and Gynecology Kaiser Permanente