- A pilot program in Texas is showing potential in its bold approach to Medicaid births, in which it combines pregnancy, delivery, and newborn care into one episode for payment and evaluation.
- While American healthcare systems typically cover costs and evaluate quality for these services independent of one another, budgeting them together is yielding positive lessons, according to a new report in NEJM Catalyst.
- The experiment in bundled payment for maternity care encourages coordination among providers and aims to incentivize delivery of care in one segment that improves costs and outcomes in a later segment.
The program in Texas didn't yield substantial savings in year one but is expected to in year two when downside risk is introduced, according the report from the program collaborators, Health Care Incentives Improvement Institute and Community Health Choice, a nonprofit Medicaid HMO located in southeastern Texas.
Further, the experience under the pilot so far has generated lessons that allow the pilot to serve as a model to help other states develop their own maternity bundled payment programs, the authors suggested.
Separately, CMS' results for models 2-4 of its Bundled Payments for Care Improvement (BPCI) similarly remained "encouraging" but inconclusive after their first year, the agency detailed in September, but it is sufficiently convinced of the potential that it is moving forward with additional models in 2017.
The Texas experiment in maternity bundled payment is relevant across the U.S given that Medicaid pays for about 50% of all U.S. births, the authors noted, and that harm from issues along the way, such as unwarranted C-sections, premature births, or low birth weight have long term implications for public health and healthcare costs.
The pilot's efforts include linking the data and records of mothers and babies, which many states do not do; creating expected delivery costs so that C-section deliveries always exceed the budget; and scorecard adjustments for tracking quality.