As the nation aims to improve care for mothers and infants, and federal legislators build on the Preventing Maternal Deaths Act passed in 2018, health systems must consider how to enhance their perinatal care while lowering costs.
Labor and delivery patients are the largest population in a hospital at any given time, totaling 10-12 percent of the census. Yet, there’s great variation in hospitals’ cost for maternity care nationwide and no surefire explanation of what drives the inconsistencies.
According to a recent analysis by Premier, complications and chronic conditions escalate hospitals’ cost of care upwards of 20 percent. Our research also shows that the instance of severe maternal morbidity (SMM) factors is on the rise. Providers must come together and solve for these issues to protect the quality of life for mothers and babies.
Maternal health quality improvement done remarkably well: the reduction in early elective deliveries (EEDs).
In 2010, EEDs accounted for 17 percent of all births despite the fact that EEDs at 37 or 38 weeks are risky. EEDs are associated with lower birth weights, increased dangers of precipitous labor, increased risk of birth injury and required ventilation.
But by 2016, the national rate had dropped nearly 90 percent to 1.9 percent – an improvement that’s typically unheard of in healthcare, especially so quickly. A series of practices contributed to the decline, including measuring and publicizing the rates; payment reform, in which states threatened to withhold reimbursements to hospitals for EEDs; and collaboration to share and support best practices.
We need to take the lessons from EEDs and apply them to cesarean deliveries and severe maternal morbidity factors.
EED success shows what can happen when legislative, regulatory and payor mandates align with the application of evidence-based care. Today, these learnings should be channeled into lowering the rate of SMM factors and unnecessary cesarean deliveries, particularly primary cesareans. SMM factors are increasing, especially among African American women, while cesarean deliveries accounted for 31 percent of all U.S. deliveries in 2018, according to Premier data.
Why target these conditions? Their long-term impact on a mother’s health cannot be understated. SMM is considered a near miss for maternal mortality and is often a direct result of mortality later in life; meanwhile, poor outcomes associated with cesareans include higher rates of transfusion, ruptured uterus and unplanned hysterectomy. SMM and cesareans also raise hospitals’ cost of labor and delivery.
Providers can tackle SMM factors and unnecessary cesareans with the right tools, strategies and models.
Here’s where to start:
- Measurement of rates and outcomes. In the case of EEDs, many providers didn’t realize how high their own rates were until watchdog groups began asking that they report them. The Joint Commission may be trying to tease out a similar effect beginning in the summer of 2020, when it plans to begin publicly reporting hospitals that have consistently high cesarean birth rates.
Legislators are also asking for more information around maternal harm and outcomes, which will encourage greater adoption of evidence-based protocols. The federal government recently signed into law key actions that require states, hospitals and providers to collect and analyze data on every maternal death in the nation. On top of that, there are numerous supporting legislative actions in process that will further require all healthcare organizations to collect and report specific maternal and infant outcomes.
Bottom line: providers are increasingly being asked to demonstrate the adoption of evidenced-based maternal safety best practices, and they’ll need accurate and reliable business intelligence to measure and report their outcomes accurately.
- Highly reliable, standardized care. Evidence clearly demonstrates that many tragic events can be prevented and the key to improving maternal death rates, preventing complications and lowering costs is to create and implement standardized population-focused approaches to healthcare processes.
Providers should craft standard care guidelines to incorporate not just the national maternal safety bundles, but also operational and quality measures, including length of stay, readmissions, cost and efficiency, as well as medical indicators for SMM risk factors, clinical conditions such as preeclampsia and behavioral health protocols. Perinatal business intelligence is paramount to understanding where performance gaps exist so providers can strategize to close them.
- Collaboration. Premier members who unite to test, design, implement and spread best practices have shown that collaboration yields results. Premier has worked for years with hundreds of hospitals and key industry associations on the development, education and implementation of women and infant safety guidelines. This includes the Premier Perinatal Safety Initiative, which united a group of hospitals and helped them reduce maternal deaths and harm by 20 percent from 2008-2013.
- Value-based care. Following in the success of bundles such as comprehensive joint replacement, a maternal care bundle encourages providers to work across care settings and proactively respond to health risks that could exacerbate complications and costs. State Medicaid programs are testing these types of bundles, as are payers including UnitedHealthcare, Humana and Cigna.
Another tact is a direct-to-employer model, which bypasses the traditional third-party payer and allows a health system to partner with a local employer in the market to care for the population of employees. General Electric is one national employer that’s been working directly with hospitals to guide employees to sites that provide better maternal care and are less likely to recommend unnecessary and costly interventions.
Premier launched the Bundle of Joy campaign to raise the bar on the quality and cost of care for mothers and babies, assimilating best practices to distribute to the industry at large over the next several years.