Catalyst for Payment Reform

South Carolina’s Birth Outcomes Initiative

South Carolina’s Birth Outcomes Initiative

We all know that the U.S. health care system needs fixing, especially when it comes to cost and access, but many of us still hold on to the notion that the U.S. produces the best quality in the world.  Unfortunately, we know that’s not the case.  A new investigative study shows that the maternal mortality rate, a key health quality indicator, has risen each year since 2000 while it has decreased in every other developed country.  Worst of all, 60% of these deaths are preventable.

What better time to revisit CPR’s work in maternity care, especially because we know we have a long way to go in this country before we can say that most maternity care follows the clinical guidelines.  There’s far too much unnecessary intervention in labor and delivery, and sadly it leads to harm for both mothers and babies, not to mention unnecessary expense.

One of the most egregious examples of where U.S. health care veers from the guidelines are early elective deliveries.  These are deliveries that occur before the due date at the mother’s choice, either by inducing labor or cesarean delivery.  Sometimes, the outcome is positive, but the intervention still adds cost to the system. Other times, there are complications, resulting in an increased likelihood that the baby will require a stay in the NICU.

The good news is that the rate of early elective deliveries has plummeted since many of us started shining a light on the practice a decade ago.  Mounting evidence of the harm, tracking the rate of these deliveries, and advocacy by employers and others have contributed to the reduction.  So have quality improvement initiatives led by providers as well as pushes for changes in provider policy by health insurance plans.

One additional approach that has yet to catch on, but should, is implementing a nonpayment policy for early elective deliveries where employers, other health care purchasers, and health insurance plans refuse to pay for elective deliveries prior to 39 weeks gestation.  In South Carolina, this policy was implemented by both the Medicaid agency and local Blues plan and it pushed their results the extra mile.  Want to know what steps to take to pursue this approach?  Check out CPR’s Case Study on South Carolina’s Birth Outcomes Initiative and How to Guide.

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