Maternity Care

Fellowship Year 2015-2016

Background

Approaching 4 million deliveries per year, birth is one of the most common reasons for hospital use in the US and is a top expenditure for payers. Between 2004-2010, commercial payment for maternity care increased by over 50%, with out-of-pocket expenses borne by families increasing four-fold. The US spends almost $82 billion per year on maternity care each year. Despite rapidly rising payments associated with childbirth national perinatal outcomes has not improved significantly over the last 15 years.

Safely reducing per capita maternity care spending

CERC’s maternity care redesign team identified three addressable failure points in current
methods to deliver high-quality obstetrical care. Team members addressed these failure points via a new care model with three core elements: (1) Provide long-acting reversible contraception (LARC) immediately after birth which can safely and effectively reduce both unplanned repeat pregnancies and the high rate of costly complications associated with short-interval pregnancies; (2) Tailor prenatal care according to women’s unique medical and psycho-social needs by offering more efficient models of prenatal care. These include (a) fewer in-person visits, which can allow providers to spend time seeing higher acuity patients or (b) group prenatal care which has been shown to reduce the preterm birth rate in certain high-risk groups (3) Create hospital-affiliated integrated outpatient birth centers (OBCs) as the planned place of birth for low-risk women to avoid the very expensive and unnecessary inpatient facility fees, and to decrease risk of unnecessary procedures like cesarean sections.

Estimated savings

A conservative estimate of national savings from full implementation of the CERC model is
$23 billion dollars in direct health care spending per year, or 28% of annual spending for
maternity care.

Authors

Victoria Woo, MD, Tiffany Lundeen, MSN, Terry Platchek, MD, Sierra Matula, MD, MSHS, Arnold Milstein, MD, MPH, 2016