- Humana will launch a bundled payment model for commercial group members with low- to moderate-risk pregnancies.
- The value-based care initiative, which will initially be available at five OB-GYN practices, aims to improve quality and outcomes while curtailing costs by bundling the expectant mothers’ entire perinatal episode of care.
- The use of data analytics will aim to enhance patient care, increase care coordination and reduce duplicative services, readmissions and complication rates, the company said.
This is Humana’s second specialty care payment model. A total joint replacement program, launched in 2016, is now available at about 40 orthopedic practices in 13 states.
Maternity bundled models aren't a new idea. There are bundles for a variety of services, including joint replacements, cardiac rehabilitation and acute care hospital stays. A few for maternity have also been tried.
In a Texas pilot program, a Medicaid HMO rolled pregnancy, delivery and newborn care into a single episode for payment and evaluation. Interim results, presented at the recent American College of Healthcare Executives Congress in Chicago, were inconclusive as to long-term savings with the program.
Of the two participating practices, one realized savings in the first year by lowering C-section rates and neonatal costs, but went over budget in year two, according to HealthExec. The other practice cited losses in year one due to infants with congenital birth defects that required more intensive nursery care, but stayed under budget the following year.
Still, new approaches are welcome, as the U.S. has the worst maternal death rate in the developed world. A report from the CDC foundation found that nearly 60% of those deaths could be prevented. There are also stark racial disparities. Black mothers die at three to four times the rate of white mothers, according to the Centers for Disease Control.
Women in rural areas have particular struggles as well. A recent JAMA study found that losing hospital-based obstetric care in rural counties is associated with more out-of-hospital, preterm births and births in hospitals without obstetric wards.
Humana currently has about 140,000 commercial members who receive care from doctors in value-based health plans across 43 states and Puerto Rico.
The five participating OB-GYN practices are in located Indiana, Kansas, Ohio and Texas.