As reimbursement continues to shift from volume-to value-based models, the demand for transformative health care that produces better outcomes continues to rise and evolve. Simultaneously, younger patients continue to seek alternative forms of care that are more individualized and patient-centered. Maternity care, in particular, is increasingly in the spotlight.
Notably, the Centers for Medicare and Medicaid Services (“CMS”) began an initiative in 2012, “Strong Start for Mothers and Newborns”, which sought to improve outcomes for pregnant women and newborns. Since that time, the dialogue on improving maternity care has continued to expand. One alternative form of maternal care that has rapidly picked up steam is the concept of a birthing center.
Typically, birthing centers are targeted toward women with low-risk pregnancies who are seeking a more comfortable environment for their pregnancy and birthing experience. Birthing centers take a more holistic approach to a woman’s pregnancy, focusing on the woman’s particular desires and needs throughout her pregnancy, complete with a midwife to help the mother-to-be through each stage along the way. Although birthing centers have been around for some time, it has long been seen as a more cost-prohibitive method for most. Despite the fact that birthing centers lead to better outcomes and lower costs for patients, historically few insurers covered services performed in a birthing center, causing many patients to pay for these expenses out-of-pocket. However, this may soon be changing.
In as early as 2014, payers began to experiment with a new type of bundled payment model for maternity care, with certain Medicaid programs leading the way. Soon, data began to show how this bundled payment model led to improved outcomes, greater patient satisfaction, and lower costs. Since then, various commercial payers have slowly begun to implement their own versions of a maternity care bundled payment model, with United Healthcare being the most recent insurer to jump on board. As the number of Medicaid Managed Care Organizations continues to surge, MCOs are continually seeking ways to maintain a competitive edge, with maternity bundled payments and alternative birthing concepts being a feasible offering for payers and an attractive benefit for beneficiaries.
At the same time, demand for the type of environment a birthing center offers, paired with the undeniable statistics supporting their effectiveness on patient outcomes, has caught the attention of hospital executives. While birthing centers have tended to be understood as freestanding and unaffiliated with a hospital, more and more hospitals have begun opening their own birthing centers, particularly in light of pressure from both state and federal levels for transformative demonstration projects from health care providers. Although birthing centers typically were not highly profitable due to inequitable payment models, the new bundled payment model for maternity care has paved the way for hospitals to improve maternal care, meet patient needs, all while maintaining the bottom line.
As the health care industry continues to demand transformative care and better patient outcomes, it is critical that providers and payers alike continue to seek out and implement new and creative methods of care in order to remain viable in the market. Specifically, as a provider, establishing a birthing center as a hospital-based facility may be a unique way to remain competitive and retain patients who may otherwise seek out a freestanding birthing center to meet an increasing desire for alternative birthing methods. By establishing a birthing center as a hospital department, providers can shift its low-risk pregnancy patients to the birthing center, taking advantage of the emerging maternity bundled payment model, while freeing up traditional labor and delivery departments for more complicated pregnancies. At the same time, having a birthing center near an already existing hospital allows birthing center patients a quick method of transfer in instances where a low-risk pregnancy turns complicated during labor, a fear that many expectant mothers consider when choosing a birthing center. This arrangement promotes a smoother continuum of care, maintains a competitive edge in the market, improves patient outcomes, and satisfies patient desires – all qualities that providers must continually strive for in the evolving healthcare landscape.
Being innovators in the healthcare space and experts in healthcare regulation, Advis has unique experience in not only establishing birthing centers for providers, but in pioneering other novel concepts to transform the provision of healthcare while improving the bottom line. If you are interested in establishing a birthing center or discussing other creative avenues to enhance your organization, contact us through our website or please call 708-478-7030.