Value-Based Maternity Care – Health Plan Alliance Session Details How to Make the Shift from Volume to Value for the OB Episode

The Health Plan Alliance recently hosted a members-only web series on maternity care, which included a special session on value-based maternity bundle design. Of all the hot topics in the maternity space, insight on effectively deploying value-based care models is top of mind for most.

Session speakers included Dr. CJ Stimson, who leads bundled payment policy and program development at Vanderbilt University Medical Center, and Leah Sparks, founder and CEO of Wildflower Health, a leading provider of virtual and value-based care solutions for women’s health. Dr. Stimson focused on VUMC’s work in clinical transformation and alternative payment models which produced a successful maternity bundle for employers, while Sparks shared Wildflower’s turnkey solution for enabling providers and payers to engage in value-based models.

The following is a summary of the guidance provided by Stimson and Sparks. The full session also includes deeper dives on the following areas:

• What barriers have slowed adoption of maternity bundles, and how do we overcome them?

• What are best practices and lessons learned from recent bundles?

• How can we design bundles to scale and work for payers and providers of all sizes?

• How should payers and providers more effectively collaborate moving forward? What roles should each stakeholder fulfill?

• What are the near-term innovations that will most dramatically influence maternity bundle design?

Health Plan Alliance Members can access the full session here.

Despite a lot of discussion, there are still too many active silos in healthcare. When no one has full scope, or accountability for the experience, patients suffer. The system as it is currently structured is not set up to deliver the right kind of care. Fee-for-service payment is one of the main culprits. There is widespread fragmentation and lack of coordination that is baked in to how providers get paid. It also yields less predictability and with no shared risk or incentive for providers, it doesn’t create alignment or accountability.

As a result, growth in medical spend is far outstripping inflation. And what do we get for that? Not much, except incredible variability of care across the country. This is true for bariatric surgery, joint replacements and even maternity care.

Value-based care has been widely considered the obvious path forward. Specifically in maternity care, the energy toward a shift to value is intensifying. But despite its obvious potential for improving maternity outcomes, the transition has proven to be extremely difficult.

So, how do we help this transition along? Here are three key priorities.

Delivery Model First, Then Financial Model

First you can throw out the rules. Start with changes to the delivery model, and then figure out the right payment structure to support it. What could we do? What would we do? The current model doesn’t work, so how do we design something from the ground up that works better? In maternity, that means thinking about the patient journey from the first prenatal visit through first three months of birth. What are the pain points? What are the specific needs? How can telehealth, remote monitoring and digital health resources best integrate with in person care? What would we do to free up clinicians to practice medicine the way they know is best for the patient? What is the right thing to do? Once you have answers to these questions, you can determine how best to finance them. A simple example. If the right thing for patients is to provide an advocate or a navigator to be their guide through pregnancy and postpartum, find a way to make that happen.

Thoughtful Economic Design That Aligns & Rewards

Next, make sure the economic design is thoughtful and fully aligns all stakeholders around both risk and reward. Many models stop short of true value-based arrangements. They are rooted in either cost or volume control. They incentivize less care, or less expensive care, but not necessarily outcomes-focused care. To move all the way from fee-for-service to value-based care requires shared risk and reward among all stakeholders. It’s important that providers share in the financial upside of improving outcomes. Only when we fully align the payment structure in this way do we create an environment where true value-based care can be realized. If an OB or a hospital helps avoid a high-risk pregnancy or a NICU baby, those providers should share in the savings that results from the improved outcome.

Tools & Services for Patient Care Transformation

Finally, most OB providers lack the software, hardware and humanware to truly engage in population health management, which is required for value-based care delivery. They need to be equipped to make digital connections with patients, continuously during and after pregnancy, including education, remote monitoring and virtual visits. They need real-time insights that help with decision making at point of care. They must be able to continuously assess risk, stratify patients and escalate at- risk patients to a health advocate or a member of the provider's care team. This is a heavy lift, and most providers will need partners who can provide these capabilities, and integrate into their existing workflows.

Want more best practices for value-based maternity care? Health Plan Alliance Members can access the full session here.  For a comprehensive discussion of what’s needed to launch value-based care in the maternity space, please visit valuebasedobcare.com to hear from many of the nation’s top experts.