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Humana Launches Bundled Payment Model to Improve Maternity Outcomes and Cost


Humana has launched a new maternity bundled payment model with 5 practices in Indiana, Kansas, Ohio, and Texas to improve quality, outcomes, and cost across the entire perinatal episode of care for women with low- to moderate-risk pregnancies.

Maternity care in the United States has a lot of room for improvement. Since 1987, pregnancy-related deaths have been steadily increasing, from 7.2 deaths per 100,000 live births to 17.3 deaths per 100,000 live births in 2013 (the last year of available data), according to data from the CDC. One way of improving maternity care may be new payment models that incentivize quality care.

Humana has designed a new value-based care maternity bundled payment model to improve quality, outcomes, and cost across the entire perinatal episode of care for commercial group members with low- to moderate-risk pregnancies. The insurer is partnering with obstetrics and gynecology (OB-GYN) practices across the country to launch the national payment model.

Humana already has a bundled payment for joint replacement that is offered at approximately 40 orthopedic groups in 13 states.

“Because quality maternity care is important for many of our members and a significant focus of specialty care services in our country, we’re very pleased to launch Humana’s newest specialty-care bundled payment model,” Caraline Coats, vice president of Humana’s Provider Development Center of Excellence, said in a statement. “Humana is dedicated to working with OB-GYNs across the country to provide a better patient experience and improve patient outcomes, while also tackling the cost challenges inherent in perinatal care.”

The bundled payment model will kick off with 5 practices participating voluntarily: Ob/Gyn Associates of Southern Indiana; Mid America Physician Services in Kansas; Seven Hills Women’s Health Centers in Ohio; TriHealth in Ohio; and Consultants in Women’s Health in Texas.

In 2016, AJMC.com contributor Katy B. Kozhimannil, PhD, MBA, an associate professor at the University of Minnesota and the director of research at the university’s Rural Health Research Center, discussed the benefits of using bundled payments in 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,” she wrote.

Other insurers have also started maternity bundled payment programs. Cigna announced a program in January, and Horizon Blue Cross and Blue Shield of New Jersey has had a program in place for years. Horizon announced in 2016 that its bundled payment program for pregnacy resulted in a 32% reduction in cesarean sections.

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