Dive Brief:
-
Rates for early elective deliveries, those performed by induction or C-section prior to 39 weeks without medical indication, have fallen from 17% in 2010 to 1.9% in 2016, according to an analysis from Castlight Health and the Leapfrog Group.
-
Rate of episiotomies have also fallen, from 13% in 2012 to 9.6% in 2016, but rate of NTSV C-section did not change significantly from 2015 to 2016.
- Seema Verma, a healthcare consultant from Indiana who is the nominee to lead CMS, indicated during a confirmation hearing that the government should not require health plans to include maternity coverage, the Associated Press reported.
Dive Insight:
The report from Leapfrog and Castlight does not delve into factors behind the decline, multiple health initiatives have targeted early elective procedures for at least several years. While the Affordable Care Act (ACA) was the most prominent health reform to include a stance on early elective deliveries, states have also acted to limit the procedures in their Medicaid programs.
At least 20 states have passed legislation intended to curb early elective deliveries, according to a report from the Kaiser Family Foundation. Some state Medicaid programs will not pay for early elective delivery at all while others pay a reduced rate or penalize hospitals through pay-for-performance arrangements. At the federal level, the ACA established the Strong Start for Mothers and Newborns Initative to promote awareness, improve reporting and share best practices around early elective deliveries.
Private payers are also less likely to cover the costly and medically unnecessary procedures than they were several years ago. For instance, Blue Cross Blue Shield of Louisiana, which covered Medicaid patients as a managed care organization, adjusted all of its health plans to deny payment for early elective deliveries in 2014.
It seems unlikely that early elective deliveries would rise dramatically if the requirement that health plans include maternity coverage is removed. However, the fall in early elective delivery rates show how a shift in federal policy coincided with and possibly encouraged policy changes in other areas. As the dismantling of the ACA continues, there will likely be ripple effects throughout healthcare.