Payers

UnitedHealthcare launches new maternity care bundled payment program

The bundled payment program is meant to incentivize better care coordination across the entire episode of maternity care which includes prenatal, delivery and postpartum services.

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As part of its larger effort to move the bulk of its business to value-based payment models, UnitedHealthcare has launched a bundled payment program for maternity care meant to help close gaps in care, support healthy pregnancies and reduce the risk of complications.

The new program, which has launched with Lifeline Medical Associates in New Jersey and Privia Medical Group – Gulf Coast in Texas, will be expanded to as many as 20 provider groups by the end of 2019. The two launch clinics are a part of the U.S. Women’s Health Alliance, a national consortium of OBGYN practices dedicated to improving the quality of women’s healthcare.

The bundled payment model applies to commercially insured members who have access to the program at no additional cost.

Maternity care accounts for one of the largest reasons for hospitalization and studies have shown large variation in cost for care across facilities.

Moreover, the U.S. ranks worse than most developed nations when it comes to maternal health, even as it spends more than any other country on hospital-based maternity care.

A recent CDC report found that roughly 700 women die each year in the U.S. from causes related to pregnancy or childbirth and three-fifths of those deaths may be preventable.

Janice Huckaby, senior vice president of UnitedHealthcare’s women’s health initiatives, said maternity care is a major priority because one out of every 10 babies born in the country have a parent who is a member of UnitedHealthcare.

Outside of its maternity care program, UnitedHealthcare has made a bundled payments a key part of their value-based payment strategies, especially in the Medicare space.

The company – which has a stated goal of shifting $75 billion of its provider reimbursements to value-based arrangements by the end of 2020 – is launching its UnitedHealthcare Care Bundles program next year which will offer providers the option of participating in bundled payment arrangements for eight medical procedures, mainly orthopedic and cardiac treatments and surgeries.

Maternity care provides a readymade entryway for the model for commercial members because of its definable “episode of care.”

“We know what good care looks like, so the question is how do we wrap around a payment model to align incentives with providers to make that happen?” Huckaby said.

She added UnitedHealthcare will use industry standards in determining bonuses for quality measures including pre-natal blood tests and ensuring that expectant mothers have regular pre-term clinical visits.

“One of the reasons that can be important in a bundle is because we don’t want to see people limiting costs by limiting access,” Huckaby said.

Currently the bundled payment model only has upside risk for provider partners, but Huckaby said the program may eventually include penalties for providers who don’t meet certain quality standards.

The bundled payment program is meant to incentivize better care coordination across the entire episode of maternity care which includes prenatal, delivery and postpartum services.

UnitedHealthcare’s program follows the lead of insurers like Humana, which launched its own bundled maternity care program last year and Cigna, which also collaborated with the U.S. Women’s Health Alliance to start its own program.

State Medicaid programs which pay for nearly half the births in the country have also taken a leadership role in creating new payment models, with Arkansas, Tennessee, and Ohio instituting episode payments for maternity care.

UnitedHealthcare has already made moves to improve the quality of maternity care through its UnitedHealthcare Maternity program, which aims to reduce the rate of unnecessary C-Sections, as well as pre-delivery hospital admissions and NICU hospital stays.

Obstetricians have also been added to the company’s premium designation program to guide patients to choosing clinicians who meet quality and cost-efficient care standards.

The insurer has also released its Healthy Pregnancy mobile app, which can connect patients to clinical staff, guide users in self-assessment and provide information about pregnancy symptoms and concerns.

“This isn’t necessarily something different, it’s sort of an evolution,” Huckaby said. “People want to do the right things, but we need make sure people are being paid for the things they want to do anyway.”

Picture: Hong Li, Getty Images