Nationwide, 700 women die annually from pregnancy or its complications, and more than 50,000 pregnant women experience a life-threatening condition. Maternal mortality rates are three times higher in women of color.
The AHIP brief suggests a transition to value-based care systems between payers and providers to align on best practices such as quality measurement and developing national content and exchange standards.
Five recommended value-based maternal care models:
- Pay for performance: Provide a bonus payment for achieving quality performance goals or adhering to clinical guidelines. May include a penalty for poor performance.
- Limited bundle payment: A payer bundles the costs of a limited set of services such as hospital labor/delivery and makes one prospective or retrospective payment for the services.
- Episodic bundled payment: A single bundled payment is made prospectively or retrospectively for the full perinatal episode of care that includes pregnancy, labor and delivery, and the postpartum period.
- Population-based payments: A fixed payment per patient for all services related to pregnancy and postpartum phases. Payments are prospective and at a regular interval.
- Total cost of care: Maternal care is included as part of the total cost of care calculation in a global budget or shared savings model based on a given year, which may or may not include a risk-sharing component.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
