Health Plans Should Consider Paying for Doula Services
There is a quiet revolution happening among health plans. Mothers and fathers who work for health insurance companies-and who had the support of a doula at the time of childbirth-are beginning to inquire about expanding benefits to include coverage for this evidence-based service.
There is a quiet revolution happening among health plans. Mothers and fathers who work for health insurance companies—and who had the support of a doula at the time of childbirth—are beginning to inquire about expanding benefits to include coverage for this evidence-based service. Because I conduct research on childbirth care, I hear a lot of birth stories (and I love hearing birth stories). Anecdotally, I have seen a pattern arise: behind every health plan innovating in the space of maternity care is a compelling birth story, backed by evidence.
What is a Doula? And Why Do Lots of People Who Work for Insurance Companies Have One?
Doulas are trained professionals who provide one-on-one emotional and informational support during pregnancy, labor and delivery, and postpartum. Doulas are not medical professionals and do not provide medical services, but work alongside nurses, obstetricians, midwives, and other healthcare providers.
Barriers to Accessing Doula Care
“Underutilized” seems to be an understatement for such an “effective tool.” In a
The Case for Insurance Coverage for Doula Services
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Understandably, health plans are cautious about the prospects of adding coverage for new benefitsespecially for high-volume conditions like birthand they need good, solid data to make such decisions. Fortunately, relevant data are emerging to support policy and administrative decision making around increasing access to doula coverage through third-party reimbursement. One example from my own work was a
Admittedly, our paper and other published studies of doula care use data that have important and relevant limitations: by the time we analyze and publish them, the data are outdated, and using administrative records always leaves out part of the story. However, health plans can and should use their own data to assess the potential for doula coverage in their own contexts.
Minnesota Experience: Recommendations from Managed Care Organizations
In September 2014, Minnesota’s state statute requiring Medicaid reimbursement for doula coverage went into effect. Minnesota is 1 of 2 states with legislation allowing Medicaid coverage of doula services; the other is Oregon. However,
Respondents noted several key challenges with implementation regarding network development, billing, and consumer outreach. In the first year of Minnesota’s experience with Medicaid coverage for doula services, the most frequently mentioned challenge was the requirement that doulas bill for services through a supervising provider and use that provider’s National Provider Identification Number for billing purposes. (This is required because Minnesota’s Medicaid program only reimburses licensed providers, and doulas are certified, but not licensed, in Minnesota.) For example, 1 payer noted that “few, if any, physicians or nurse practitioners have agreed to act as a supervising provider due to quality concerns and liability.” Another organization noted that “most doulas have operated independently, rather than under the auspices of a specific provider or provider group; the women they support receive care from a wide variety of providers and deliver at a variety of hospitals” making the requisite supervisory relationship a challenge.
In addition to highlighting this key challenge, respondents offered several recommendations for improving implementation of the doula benefit under Minnesota Medicaid, and these suggestions may also be applicable to private health plans or self-insured employers considering the possibility of extending benefits to include doula services.
- Establishment of a unique provider type for doulas, which would be used by all health plans.
- Facilitating a dialogue with clinics to understand their perspectives on doula care and piloting doula care within clinics where the health plan has an established relationship.
- Educating the doula community about the Medicaid fee schedule and the process of contracting with health plans.
- Educating plan members on the benefits and value of doula care.
Overwhelmingly, managed care organizations emphasized the complexity of the relationships between members, clinics, medical providers, doulas, health plans, and regulators, but all of the respondents also highlighted their interest in overcoming barriers to improve access to doula services.
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The idea to reach out to health plan CEOs to solicit their insights and recommendations for change came from a colleague who works at a health plana colleague who had a wonderful birth experience supported by a doula. As the evidence base around the potential benefits of doula access grows, and as more families experience these benefits, the conversation about inclusion of doula services as a covered benefit has extended beyond the water cooler and into executive suites and legislative discussions, where it belongs, as our country grapples with troubling trends and persistent disparities in birth outcomes.
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