Much like the Accountable Care Act (ACA) debate in 2010, the current political debate over repealing and replacing the ACA is focused on coverage and cost.
Much like the Accountable Care Act (ACA) debate in 2010, the current political debate over repealing and replacing the ACA is focused on coverage and cost. Aligning provider and payer incentives to reward value-based health care is key to addressing the escalating costs facing the healthcare industry and nation. We urge policymakers to accelerate value-based care by rewarding clinical quality and cost-efficiency in the U.S. healthcare system in order to reduce costs and drive innovation and care delivery transformation.
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While President Trump and Congress consider plans to transform healthcare, we believe they don't have to look far for sensible models to control costs and improve quality. The ACA includes programs that drive value-based care, where doctors and hospitals profit from good outcomes rather than volume. This idea of value-based care predates the ACA in alternative payment models like bundled payments and global fees.
The premise behind bundled payments and global fees is to encapsulate a suite of procedures and services from one episode of care (like a knee replacement) into one fixed fee. These changes evolved as innovative insurance companies and providers realized that standardized protocols that control cost and optimize outcomes could be paid through a single reimbursement.
Maternity care stands out as an early adopter and great example of sensible payment reform from which we can learn. Maternity care providers long ago embraced payment mechanisms that value quality over volume. Their embrace of technology to positively impact care, manage risk and control cost are exemplary. The architects of the new “replacement” healthcare plan should study how maternity care is evolving to see how other service sectors can follow suit to make affordable care a reality.
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For more than 30 years across the United States, maternity care providers have received a flat fee from insurance companies or Medicaid for prenatal services (excluding hospitalization costs) for a routine pregnancy and delivery. This lump sum payment, known as a global fee, motivates maternity care providers to better manage costs while engaging patients so healthy mothers deliver healthy babies. Prenatal global fees are one of the earliest examples of value-based care.
While maternity care has been forward-looking in adopting value-based payments, more must be done to transform other clinical conditions to value-based care. Obstetrics evolved with the introduction of screening mechanisms and technology to confirm patients were healthily progressing through their pregnancy. Smartphones and new technologies can transform care delivery in all clinical disciplines. We believe that new digital tools and platforms are the key to helping physicians manage real-time patient risk, evolve toward value-based care and accelerate the transformation of care delivery.
With mobile telemedicine platforms, obstetricians and pregnant women are improving their ability to meaningfully interact between visits. Real-time readings from connected scales, blood pressure monitors and glucometers connected to the patient’s smartphone, create comprehensive data sets. This data provides a better picture of a woman’s pregnancy and health status, allowing both the care provider and the patient to be more engaged. As care delivery organizations are offered the necessary tools to monitor patients more closely, they will be better equipped to assume more risk and accept fully capitated payments, which would cover all pregnancies from conception to postpartum.
Innovative health systems around the country are adopting this mindset to improve the quality of care while reducing cost. Health systems in South Carolina, for example, have engaged payers to cover the cost of telemedicine visits during pregnancy, greatly increasing access to necessary care. Other health systems around the country are deploying remote monitoring solutions to better engage with their patients between visits.
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In North Carolina, Cone Health has partnered with innovative companies to reduce the cost of outpatient prenatal care by 40%, detect cases of increased patient risk earlier through remote patient monitoring and deliver more personalized and convenient care experiences through technology for pregnant patients.
We believe that individuals, policymakers, care providers and insurance companies can learn from these experiences and the application of this groundbreaking set of tools. A combination of payment and technological reform is crucial to ushering in a new wave of partnership among these stakeholders. Maternity care 2.0 is just the beginning.
OECD (2015), Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives, OECD Publishing, Paris.
Kozhimannil KB. A Bundle of Joy? Bundled Payments for Maternity Care. The American Journal of Managed Care. May, 28, 2016.
. Issue Brief No. 10. Integrated health care Association. Sept. 2013.
Williams T, Yegian J. Bundled Payment: Learning From Our Failures. Health Affairs blog. August 5, 2014.
About the Authors
Juan Pablo Segura is co-founder and president of Babyscripts, a Washington, DC-based technology company that builds mobile and digital tools to empower women to have better pregnancies.
Kelly Leggett, MD, is a practicing OB-GYN and the clinical transformation officer for Cone Health in Greensboro, North Carolina.