Overview
Pregnancy and childbirth are life-changing, monumental experiences that greatly impact the gestational parent and form the basis for a child’s future. The United States has the highest maternal mortality rate of developed countries and vast inequities based on race and ethnicity in both maternal and infant mortality. Cesarean-section rates remain high despite much effort to increase appropriateness. Labor and delivery are expensive, in many cases the most expensive area for health plans and purchasers with wide variation in price. In Washington State, Medicaid pays for more than half of births.
While much of maternity care reimbursement is structured as a limited bundled payment, expanding these definitions and adding clinical components and required quality metrics tied to gain-sharing can address some preventable complications by increased care coordination and the potential for better adoption of evidence-based best practices. Various bundled payment models are being used across the country by state Medicaid agencies, health plans, and others that offer examples and guidance.
The Bree Collaborative elected to develop an episode-based payment model, or bundled payment, for maternity care and has convened a workgroup that met from January 2019 to November 2019. This guideline presents a payment model that includes prenatal care, labor and delivery, and postpartum care along with clinical components for internal quality tracking and performance metrics.
Authors: Bree Collaborative
Adopted: January 2020