According to Milliman’s 2023 white paper, “Managing maternity costs and outcomes,” spending for maternity care in the United States is rising for both payers and patients without an appreciable improvement in quality. Based on 2019 figures from the Health Care Cost Institute, the United States saw maternity costs that were more than 125% of those for Switzerland, Germany, Spain and five other countries. At the same time, the United States experienced a maternal mortality rate at least double those of the other nations in the study.
There are several potential causes for discrepancies between costs and maternal mortality in the United States, where 60% of maternal deaths are deemed preventable:
- Increased age of motherhood
- Increased complications from pre-existing, chronic conditions
- Fewer midwives or overall pregnancy care providers
- Health care inequities across race, socioeconomic status, age, language and geography
The dire statistics point to the urgent need to improve the country’s maternity and delivery management.
Now for the Good News
Despite these discouraging trends, the Milliman paper also found that data-driven solutions and alternative payment models that reward value rather than volume hold significant promise. Ruchi Talwar, MD, Assistant Medical Director, Episodes of Care, Vanderbilt University Medical Center (VUMC), wrote a response to the Milliman paper showcasing Vanderbilt’s MyMaternityHealth Bundle as an example of how a bundled approach can revolutionize maternity care for a broad population.
The bundle has two goals: 1) create an enhanced patient experience through the delivery of value-based maternity care and 2) provide employers with more reliable and predictable pricing of maternity services. It is targeted to self-insured employers who would benefit from more predictable maternity care spending.
MyMaternityHealth: A Comprehensive Approach
This innovative model covers the entire pregnancy episode, including prenatal visits, emergency department services related to the pregnancy, obstetric triage evaluation, labor and delivery, and 12 weeks postpartum care. Unlike other bundled care models, it also covers any ancillary services primarily related to the pregnancy episode such as laboratory testing, immunizations and radiology studies. Patients can access newborn care and breastfeeding support classes, as well as a lactation consultant via telehealth. Routine newborn nursery care through the VUMC Department of Pediatrics is also included.
What’s more, the MyMaternityHealth Bundle does not exclude any pre-existing conditions, plus it incentivizes vaginal deliveries as well as other quality outcomes and markers of maternal wellness. To maintain control over costs, all services are provided at a VUMC location. Routine obstetric care is performed by the patient’s choice of a VUMC obstetrician, maternal-fetal medicine specialist, resident, midwife and nurse practitioner. Patients also can choose telehealth opportunities with home-monitoring devices, including a scale, blood pressure monitor and fetal doppler.
Patient navigators play a critical role in the MyMaternityHealth Bundle, serving as patient advocates to streamline care coordination and help patients navigate the VUMC system. Patients can access their navigators online or via phone or email. Navigators answer eligibility questions, enroll patients, assist with scheduling, address questions and concerns, and ensure a smooth experience. They also send email reminders of “what to expect” to ensure patients are equipped with the right information at the right time.
High Quality Without High Cost
Navigators contribute to achieving the overall goal of MyMaternityHealth—providing everything the patient needs and nothing they don’t. This reduces the use of expensive, preventable and often unnecessary services such as emergency department visits and triage. The resulting cost savings allows the MyMaternityHealth Bundle to be offered at low to no out-of-pocket costs for the patient, and the unique shared-risk model allows for inclusion of high-risk pregnancies. It also promotes overall maternal wellness and improved outcomes by measuring objective quality metrics throughout the episode. While outcome measurement is ongoing, initial quality metrics are favorable.
A Win for All Concerned
Overall, VUMC patients give high marks to MyHealth Bundles. The program’s Net Promotor Score, a common assessment of customer experiences across many industries, is 85, significantly higher than the health care industry average. Another measure of the success of MyMaternityHealth is its growth in volume, which increased by 246% from 2019 to 2023, with additional employer contracts executed in 2024.. Finally, initial data suggests that the program has generated substantial savings for both employers and patients. It has also improved the margin on maternity care, signaling that it can be a viable option for other health systems.
You can read Dr. Talwar’s full response here.
