Maternal Care: Value Based Payer Strategies to Reduce Costs
Written by David Blaszczak, Senior Advisor at SCALE Healthcare
Bottom Line: In proportion to the amount of American women pay for maternity care, mortality rates are far higher than other comparable high-income countries. In order to combat high costs and low-quality care, payers are looking to value-based payment models for a way to align care incentives, transform healthcare delivery, enhance patient experience, and improve overall health outcomes. We see the trend of value-based care and payment becoming the norm in healthcare and taking shape in a hybrid payment model that encourages evidence-based care and has the end goal of healthier mothers and babies. Preparing for a switch to value-based is a crucial next step to providing quality care to current and future patients to come.
As costs of maternal care continue to rise, more and more payers are beginning to embrace value-based care and payment models to continue delivering high quality care at a fraction of the current prices. According to a recent report by AHIP, the United States does not measure up to other high-income countries when it comes to maternity care and mortality rates. With 50,000 women having life threatening complications during labor and 700 deaths during labor annually, the United States has been looking for ways to improve maternal health outcomes without driving costs up further. Value-based care is a natural next step in many national payers’ cost reduction strategies, as it places a focus on performance and quality of care rather than payment for each service done, as under FFS.
Some options payers may switch to under the value-based model include the following:
- Pay for performance
- Limited bundle payments
- Full episode bundle payments
- Population-based payments
- Global Budgets
The pay for performance model would make payments as a reimbursement in relation to the health outcomes of the service and quality of care. This may look like reimbursement amounts based on the number of complications during pregnancy and birth as well as the health or status of the child once delivered. Payment under the limited bundle model would be like a lump sum amount for a certain group of services provided. This would look like grouping the costs for provider services rendered at childbirth, like anesthesia, obstetric care, nursing, etc. Like the limited bundle payment, full episode bundle payments would similarly provide a lump sum for services provided but would include a greater number of services together. This would take form in providing one payment for the entirety of the labor and delivery. Population-based payment would be similar to bundled payments; however, the payments would be split up into installments for the duration of the pregnancy. A final payment strategy being considered is the global budget. This payment type would consider maternal/maternity care as part of a patient’s yearly care so payment would be calculated by not only the patient’s maternity but other services they need throughout the year as well.
Preparing your practice for a move towards value-based payment models would help maximize funds received while maintaining high-quality care for mothers to be. With a few national payers already utilizing value-based payment models for maternity care, preparing for the inevitable switch can establish your practice as trailblazer when it comes to delivering quality care for patients, while also addressing social determinants of health and keeping costs low. Anthem Blue Cross Blue Shield has implemented a bundle payment for the entire perinatal period for its members that are on Medicaid. Along with this, Anthem Blue Cross Blue shield has also created an “Episode-Based Payments Value-Based Care Program,” to promote and manage the coordination of care for women’s health. Part of this program works to empower providers to build on efficiencies to continue improving maternity care and share cost savings. Cigna has also joined the value-based payment model movement and is collaborating with perinatal groups across the country to create a bundled payment program. The two payers aforementioned are not the only national payers looking to value based payment models, Horizon Blue Cross Blue Shield of New Jersey, Humana, and Providence Health and services are in the mix for full episode bundled payment strategies as well. Based on current national payer trends, it is likely that a hybrid of the 5 value-based payment strategies will begin to form, as payers experiment with new programs and continue to see positive results.
SCALE Healthcare can assist with navigating the switch to value-based payments by creating new value-based care models to address patients’ healthcare and social needs, while maintaining high quality care.
Contact David Blaszczak for questions or comments about this article.