5 Lessons Learned from the Trenches: Implementing Value-Based Maternity Care to Radically Improve Maternal Health Outcomes
September 5, 2023
The maternal health statistics in this country are heartbreaking. The United States has the highest maternal mortality rates in the developed world, despite paying the most for the care itself. As a new mother, I experienced firsthand the fragmentation in our system that leads to poor care and outcomes. As a healthcare technology executive, I decided to do something about it, transforming Wildflower into one of the first companies bringing value-based care to women’s health.
As an early enabler of value-based maternity care, Wildflower has encountered a lot of “firsts” as an organization. One is introducing the industry’s first truly comprehensive bundle for value-based maternity care. Our model is designed to positively impact access, equity, quality and cost of care while bringing together both payers and providers to accomplish all of this on a single platform. Our bundle includes financial, clinical and operational models that align providers, payers, and patients around a value-based approach that rewards lower costs and better outcomes. For patients, that means finally having access to higher quality, more affordable care.
To design this bundle, we analyzed $1.65 billion worth of healthcare claims, which included more than 150,000 birth episodes. We also analyzed normative data with an additional 200,000 birth episodes. While this data was invaluable in creating an initial structure for a value-based maternity bundle, we have learned several important lessons for designing a successful bundle after implementing it for multiple clients and engaging with thousands of patients. Below are our top five insights.
- The economic design of the model must be simple and align with clinical goals. It’s important to make sure you are aligning the financials with the behaviors you are trying to incent. In obstetrics (OB), that means not limiting the bundle to only prenatal care, or even just prenatal and labor and delivery (L&D). You must include both mom and baby in a total cost of care model to fully align incentives and create a model that works. It’s also important that you create total transparency in the process.
- You have to spend money to make change. Investments are needed for care transformation to yield the quality, outcomes and savings desired. Every specialty will have different needs, but in OB, that means amplifying the capabilities of primary providers so they are equipped to remotely monitor patients and offer digital check-ins between visits, among other things. OBs are not in a position to make significant financial commitments in this arena and wait a year or longer to see a return on the investment. It’s important that payers are prepared to make an initial investment in tools that help providers transform care at the outset of a value-based model.
- As with all things healthcare, data is key. Providers need insights before, during and after a value-based model is up and running. Claims data alone doesn’t help providers take action; they require integration with clinical EHR data to drive actual insights. Providers need access to information at point of care to make the best decisions for patients. They also need to be informed on which types of patients and interventions have the biggest opportunities for quality and savings improvement in order to guide how they engage at the point of care. Along the way, they also need feedback on whether the model is generating desired savings.
- The administrative pain must be mitigated for both payers and providers. Most providers aren’t poised to deal with the operational burden involved with value-based care. A simple example is identifying patients in their practice who are part of a value-based contract, versus those who are not. The more you can integrate this model into a practice’s workflow and automate the process, the better. This starts with being able to quickly and easily identify patients who are part of a value-based contract.
- It is extremely difficult to unlearn how healthcare has traditionally worked. But that is absolutely critical to success in value-based care. Payers and providers have to approach this as a truly new way of delivering and financing care. It is fundamentally different than the legacy fee-for-service infrastructure. The days of wrestling over individual claims payments are over the moment you engage in a value-based model. Instead, these models require payers and providers to more closely collaborate and set aside legacy constraints that no longer have a place at the table. Again, it isn’t easy to approach care delivery through a completely fresh set of eyes. So, it requires a commitment to constantly re-orienting to a new paradigm.
To bring all of this together, value-based models are most successful when there is a strong partnership among all stakeholders: providers, payers, patients and third-party solution providers who are enabling the transition to value. All parties have to be aligned and actively pulling in the same direction for this to work. It’s impossible to stress just how important communication is to this equation. You need provider engagement. You need participation from patients. You need consistent feedback to adjust and optimize the model. None of this is accomplished without effective communication.
That applies to patients as well. Case in point: One patient we recently engaged was concerned about her current pregnancy because she had struggled previously with diabetes and preeclampsia, as well as pregnancy loss. She had been prescribed a Glucometer, which she was very excited to use. But she was really worried about her insulin levels. Our advocate helped her find a diabetes management program that was available through her employer. We also were able to get her primary care physician back into the loop on her care. She was being managed by multiple OBs, and her PCP was not aware of everything happening with her. With additional support and her entire care team on the same page, this patient was in a much better situation and felt much more confident that she could have a healthy pregnancy.
Success stories like this with thousands of patients have informed the lessons we’ve learned about VBC. But perhaps the biggest lesson learned is this: Value-based care works for women’s health. It’s not without challenges and complications, but it does work. Even more importantly, it must work. The trajectory of outcomes for women’s health in this country is unacceptable and unsustainable. Averting it requires bold innovation and a commitment to change. Value-based care offers us a way to transform how we care for women. As an industry, it is incumbent upon us to make value-based care successful. This model represents our best chance to do the right thing for women and meaningfully innovate the system. It’s up to us to ensure it reaches its true potential.