UnitedHealthcare, a UnitedHealth Group, today introduced a new bundled payment program for maternity care to help support the well-being of moms and babies before and after delivery by closing gaps in care and encouraging healthy, full-term pregnancies. The new bundled payment program will help close gaps in care and encourage healthy, full-term pregnancies, supporting moms’ and babies’ health and reducing risks of complications before and after delivery.
Bundled Payment Method
The bundled payment method reimburses a care provider or hospital for a defined episode of care (EOC), such as prenatal, delivery and postpartum services, under a single fee or payment. This is a shift away from the common fee-for-service structure in which a care provider is paid for each treatment, appointment or test, generating multiple claims within a single, broader episode of care. Bundled payment methods reward care providers for value over volume, helping align incentives and linking reimbursement to the delivery of coordinated, efficient care.
Bundled Payment Program for Maternity Care Overview
The new bundled payment program for maternity care has already launched with two healthcare providers, Lifeline Medical Associates in New Jersey and Privia Medical Group – Gulf Coast in Texas, to help encourage more coordinated care and better health outcomes for expectant mothers enrolled in UnitedHealthcare employer-sponsored health plans. By year-end 2019, UnitedHealthcare will expand the bundled payment program to as many as 20 care provider groups, including ones affiliated with the U.S. Women’s Health Alliance, a national organization of leading health care practices. Mothers enrolled in UnitedHealthcare employer-sponsored plans will have access to the program at no additional cost.
New Payment Model Builds on UHC’s Existing Matnernity Program
The payment model builds on the UnitedHealthcare Maternity program, which has helped women by contributing to fewer non-medically indicated cesarean (C-section) deliveries, reduced both pre-delivery hospital admissions and the average length of stay in the neonatal intensive care unit (NICU), and decreased other delivery and newborn-related costs.
The C-section rate for low-risk pregnancies among women enrolled in UnitedHealthcare’s employer-sponsored health plans in 2018 was 18 percent,1 lower than the 23.9 percent target set by the federal government. Approximately one-third of babies nationwide are born via C-section, according to the Centers for Disease Control and Prevention (CDC). Studies have shown that early, non-medically indicated C-sections are linked to a higher risk of complications, including infection, hemorrhage or blood clots, and admission to the NICU.
The UnitedHealthcare Healthy Pregnancy mobile app and Maternity program provides expectant women with personalized content and 24/7 nurse support. Nurses can coordinate care, help with the management of chronic conditions, and connect pregnant women with behavioral health care teams for emotional and mental health support. These resources are provided in collaboration with Optum, UnitedHealth Group’s health services business. Employers can offer these resources to their employees at no additional cost as part of their benefit plan
UnitedHealthcare’s Commitment to Value-based Care
The maternity care bundled payment program is part of UnitedHealthcare’s ongoing commitment to value-based care. By the end of 2020, the company expects to have $75 billion in care provider reimbursements tied to value-based arrangements annually, which support the health of UnitedHealthcare plan participants at no additional charge.
Why It Matters
“These resources can help improve access to quality, coordinated care, offering important support to women and families before, during and after delivery,” said Janice Huckaby, M.D., who leads UnitedHealthcare’s women’s health initiatives as a senior vice present and regional chief medical officer. “Value-based care programs such as this help improve clinical quality, patient safety and satisfaction, and care coordination among physicians, with the goal of reducing costs.”