In the recent article titled “Bundles of Joy? How new payment models for maternal care could deliver lower costs” in Modern Healthcare, a healthcare executive in the article states that “the devil is in the details” and maternity bundles can be hard to implement because they are “so complex.” Like any new initiative in the US healthcare system, the implementation of an alternative financial model can be challenging. However, one of the first steps before entering into a bundled payment model is to identify where costs can be saved.
Nearly 1 in 10 babies are born prematurely each year. According to the Institute of Medicine, the national societal costs of preterm births, including health care and services for short- and long-term health complications, is over $26 billion annually.
Findings from multiple research reports conclude mental health and psychosocial issues are one of the primary drivers for high healthcare costs and unequivocally contribute to preterm births. By not addressing these aspects of health that can adversely affect a pregnant woman and her baby, preterm births will continue to be a huge healthcare expense and a barrier to successfully implementing maternity bundled payments.
Maternity Bundled Payment Logistics
The maternity bundle payment, similar to other bundled payment models, should include all services provided to the patient with allowable exceptions, such as known congenital conditions. Although many claims payment systems have yet to build the infrastructure for bundled payments, the components to implementing a successful maternity bundled payment include patient risk stratification, a payer/provider risk model, and an interdisciplinary care team to address all aspects of a woman’s health.
Patient risk stratification can help determine the amount of the bundle payment and financial risk to all involved. Payer and providers can agree upon a risk stratification method in order to identify low-, medium-, or high-risk pregnancies.
Regarding the payer/provider risk model, physicians have a significant impact on healthcare services utilized because they work directly with patients to make important healthcare decisions, especially when it comes to prenatal care and delivery of a child. As a result, physicians and physician groups should be included in the financial risk and reward of a maternity bundle.
Further, insurers should not shy away from high-risk patients. With an interdisciplinary care team and a bundle that begins at pregnancy confirmation, risks are often mitigated or reduced and as a result, can have the biggest return on investment. For instance, coordination models provide prenatal care and services that address aspects of women’s health, such as mental, environmental, and physical health. As a result, adverse pregnancy outcomes can be reduced. While these models are not created equal, successful models incorporating all aspects could form the foundation of a bundled payment program to mitigate risk, improve patient outcomes, and reduce overall episode costs.
For instance, in Signature Medical Group’s (SMG) maternity care home model, every patient who is a pregnant Medicaid beneficiary is provided with a nurse navigator and maternity care coordinator. Our team uncovers unidentified chronic medical conditions and performs psychosocial risk assessments throughout pregnancy to identify and address patient-specific needs that impact the risk of a preterm birth. Patients are referred to healthcare specialists for smoking and substance use counseling, behavioral health counseling, dental care, vision care, and management of chronic medical conditions. Based on their needs, patients are connected to community resources for housing, food security, transportation, childbirth classes, nutrition education, and more. The result is a promotion of healthy pregnancies and reduction of factors associated with preterm birth and adverse birth outcomes
Our comprehensive care throughout pregnancy has generated an estimated $10-15 million in cost savings for Missouri, decreased SMG’s preterm birth rate by 20.4%, and decreased NICU utilization by 23.8% compared to Missouri statistics. Further, we have increased our HEDIS measures:
- 83% of patients attended their postpartum visit
- 86% of patients attended 80% or more prenatal visits
- 94% satisfaction rate
Maternity Bundled Payments: A Not Too Distant Reality
I disagree that maternity bundled payments will need a “large regulatory push” to succeed. Mostly because I know it can succeed with contracts between insurance companies and providers. Additionally, insurance companies do not need to wait for a bundled payment program to start realizing maternity savings. By implementing comprehensive maternity care models early in pregnancy that address psychosocial needs, maternity care costs can be reduced and outcomes improved. By implementing comprehensive maternity care programs, insurance companies are one step closer to maternity bundled payment models and will be more likely to maximize success and save millions of dollars annually in the short- and long-term. Insurance companies should not be wondering if they will save money by implementing a maternity bundled payment, it is a matter of how much money.
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-SMG Value Based Payment Team