The United States is the most dangerous place among high-income countries to give birth, and the nation's maternal mortality rate is the highest it's been since 1965. New research from Elevance Health demonstrates how initiatives from health insurers such as obstetric consultants and value-based incentive programs can lead to improved maternal outcomes for some of the nation's most at-risk populations.
"You can tell from this study that combining the two is the secret sauce," Tiffany Inglis, MD, medical director of clinical programming and population health at Elevance Health, told Becker's. "It's wrapping around the full support and also giving providers the incentive to do better."
In 2015, Elevance began developing an initiative to improve communication between its Medicaid managed care plans and obstetric providers by hiring OB practice consultants, or OBPCs. The consultants work with providers on the best data, practices, and evidence-based guidelines to address challenges often encountered when trying to address maternal outcomes.
"With Medicaid specifically, some of the barriers with improving maternal outcomes is that it's a state-by-state program that covers different services. It's hard to create an end-to-end solution that really works," Dr. Inglis said.
Today, the company has 33 OBPCs that partner with over 2,400 providers in more than 25 Medicaid markets nationwide, with expansions occurring within 10 commercial markets as well.
Elevance has also developed the Obstetric Quality Incentive Program (OBQIP), which offers bonus payments to providers who meet specific performance measures among Medicaid members during the pregnancy and postpartum periods.
In total, the OBPC and OBQIP programs have demonstrated a positive return on investment, with each independently achieving more than $5 million in savings, according to the study. Elevance also uses provider feedback and performance metrics to evolve the program every year.
"Anytime there's a complicated problem, it requires a complicated fix. No one is going to fix this alone," Dr. Inglis said. "We can do a better job across the industry of really supporting one another to actually get what everybody needs, when they need it, without making it a disjointed experience for the member or the patient."
Seven key study results:
- C-section rates were 4 percent lower with the OBQIP. Primary C-sections were 6 percent lower with the OBQIP and 9 percent lower with the OBQIP+OBPC.
- Vaginal births after C-section were 30 percent higher with the OBPC and 22 percent higher with the OBQIP+OBPC.
- NICU admission rates were 16 percent higher with the OBPC and 17 percent higher with the OBQIP+OBPC, but length of NICU stays were 17 percent lower with the OBPC and 14 percent lower with the OBQIP+OBPC.
- Preterm birth was 11 percent higher with the OBPC and 9 percent higher with the OBQIP+OBPC. The rate of low birth weight was slightly lower across all study groups.
- Timely prenatal care was 12 percent higher with the OBQIP and 5 percent higher with the OBQIP+OBPC. The adequacy of prenatal care rose 14 percent with the OBPC and 15 percent with the OBQIP+OBPC.
- Postpartum visits increased 28 percent for the OBQIP, 50 percent for OBPC, and 91 percent for the OBQIP+OBPC.
- Total birth costs were 5 percent lower with the OBQIP+OBPC, and NICU costs were nine percent lower with the OBQIP.
The study evaluated more than 29,000 Medicaid deliveries from January 2019 to June 2020 where the mother and the baby could both be identified through claims. There were three study groups that were each compared to a different control group.
Study limitations: The methodology assumes that members in each program are similar to members not in the program to find differences between groups. The evaluation could adjust only for observable differences, so adjusting for differences between groups was limited. Finally, OBQIP usually works with the highest performing providers, while OBPCs usually target lower-performing providers, which may influence the results.