The rising costs of healthcare generally, and the high costs of childbirth in the United States, are forcing innovation in payment models for maternity care alongside the ongoing efforts in other clinical areas.
The rising costs of healthcare generally, and the high costs of childbirth in the United States, are forcing innovation in payment models for maternity care alongside the ongoing efforts in other clinical areas. As a time-limited condition, maternity care may be uniquely well-suited for bundled payment models, which associate 1 global fee with provision of a set of services. Indeed, a range of different stakeholders—from health plans (like Horizon Blue Cross and Blue Shield of New Jersey) to self-insured employers (like General Electric) to freestanding birth centers (like the Minnesota Birth Center)—are all piloting bundled payment models for maternity care. These experiments highlight the appetite for value in maternity care and the interest in bundled payments by both public and private payers. The innovators in maternity care bundled payments vary widely in their approaches, and our field will learn from their experiences as adoption of this strategy continues to accelerate.
The recent draft White Paper, “Accelerating and Aligning Clinical Episode Payment Models: Maternity Care” written by the Clinical Episode Payment Work Group of the Healthcare Payment Learning & Action Network aims to propose a framework for clinical episode payment for maternity services that effectively advances the goals of the Triple Aim. The group’s recommendations offer helpful guidance to payers, providers, and healthcare delivery systems that seek to improve maternity care through payment reform. They designated 3 operational considerations: stakeholder perspectives, data infrastructure, and regulatory environment, and highlighted 10 design elements for a maternity care payment bundle: quality metrics, episode definition, episode timing, patient population, services, patient engagement, accountable entity, payment flow, episode price, and type and level of risk. The White Paper highlights research findings relevant to each of these and provides specific recommendations for all 10 design elements, in the context of maternity care bundled payments.
The recommendations are in draft form, and the integration of comments from the perspectives of diverse stakeholders will further enhance the usefulness of the framework for episode-based payment of maternity care. There are a few key areas where additional discussion and attention may be warranted:
Bundling for maternity care payments holds promise not only for health plans and healthcare delivery systems, but also for frustrated patients who struggle to get information on the costs of maternity care. Bundled payments may allow for greater flexibility, improved rewards for high performance, and higher value for each dollar spent, and the successes and challenges of today’s innovators will inform future endeavors in maternity care payment reform.