Value-Based Care Models That Could Lower Maternal Care Costs

Maternal healthcare costs in the US are too expensive, but value-based care may provide a solution, according to a brief from AHIP.

“Americans need and deserve safe, high-quality, equitable and affordable maternity care,” Matt Eyles, president and chief executive officer of AHIP, said in a press release. 

“More and more, health insurance providers and their care provider partners are embracing value-based care and payment models to align incentives, transform care delivery, enhance the patient experience, and improve outcomes for both this generation and the next.”

AHIP suggested five ways that payers can leverage value-based care arrangements in order to lower costs.

Payers can bring pay-for-performance value-based care arrangements into maternal healthcare. In this model, they would reimburse providers based on the outcomes of maternal healthcare quality measures and clinical guidelines.

Alternatively, payers could bundle together a limited set of services into one cost. For example, an insurance company could bundle together the costs of a hospital delivery, which can include routine obstetric care, anesthesia, radiology, prescriptions, and more.

Instead of creating a bundle for a limited number of services, payers could institute one bundle payment for the entire episode of care for childbirth, starting in the pregnancy stage and stretching through the postpartum period.

“There is not the same concern with a maternal bundle as there is with, for example, an orthopedic bundle where a patient may be inappropriately steered into an unnecessary procedure,” the brief noted.

Payers could assign a population-based payment covering all pregnancy and postpartum services, divided into regular payment periods. This would be a population-based payment approach.

Lastly, insurers could use a global budget or shared savings model value-based payment arrangement. In such a model, maternal care would be considered just one piece of the larger payment for patients’ annual care. This model type may include risk-sharing.

A sixth option would be to combine elements of these models to form a hybrid, AHIP suggested. 

For example, a payer could use a population-based payment model to cover pre-natal costs, a bundled payment model to cover labor and delivery services, and another population-based payment model lasting a certain number of weeks or months for the postpartum period.

These population-based and bundled payment models could even rest within an overarching global budgeting model, AHIP noted.

By instituting these payment models, insurers may be able to more effectively and affordably cover the costs of pregnancy. However, there are also steps that policymakers can implement to make pregnancy services more financially accessible.

AHIP recommended that the Center for Medicare and Medicaid Innovation uphold multi-payer models that allow payers to test value-based care arrangements under a total cost of care approach for various populations of patients.

Additionally, in order to support value-based care design, healthcare agencies including HHS and the Veteran’s Administration should create core quality measures for models serving the pregnant population.

Agencies and payers should also recognize that these value-based care arrangements present an opportunity to advance health equity. Maternal health outcomes for pregnant people are starkly divided along racial lines. 

Policies that promote value-based care arrangements should also incorporate social determinants of health and health equity goals and best practices, AHIP urged. Models could be constructed with funding set aside for partnerships with community-based organizations that will be able to identify and address local health equity gaps.

Finally, recognizing the tie between value-base care and interoperability, policymakers should support social determinants of health data collection and demographic data collection. 

“Standards for digital measurement of maternal and child health care will permit the integration of new data sources beyond claims such as directly from the medical record and patient-reported outcome measures, as well as significantly reduce the time and resources devoted to measurement,” the brief explained.

Finding a way to lower costs for pregnant people is crucial to preserving patient financial stability. Pregnant people are more likely to face catastrophic-level out-of-pocket costs than non-pregnant people, a study from Obstetrics & Gynecology showed.