Maternity care: The challenge of paying for value


TriHealth of Cincinnati is testing the waters of value-based payment for maternity care.

The impetus came from a Cincinnati-based employer that contracts with TriHealth under its self-insured health care plan, according to Jennifer Pavelka, project lead for the health system’s Maternity Bundling Care Select Program.

“Employers are looking at the value proposition and are having keen interest in the achievement of the triple aim of optimal outcomes, optimal experience, both with a mindfulness on value, Ms. Pavelka said in an interview. “An employer that had extensive experience with other episodes of care [payments], particularly in the space of knee and hip replacements in the orthopedic world, wanted to dip their toe into a value-based program for maternity.”

TriHealth, Mike Mattingly
Dr. Marcotte and Ms. Pavelka
At TriHealth, administrators and physicians created a maternity bundle based on the kind of patient rather than the services that could be offered, in an effort to ensure that the risk taken on fits in with the program’s goals. The bundle is flexible, including routine prenatal care, delivery, newborn care, and postpartum care, as well as nonobstetric charges such as anesthesiology, and patient education; it has evolved somewhat already in the last couple of years.

“Many forays into value-based payments are very much code driven, saying this code, this service is included in the bundle and this is not,” Ms. Pavelka said. “Part of what makes our work really challenging and exciting is the fact that we have taken in the realm of the methodology and philosophy of bundles, we are implementing a prospective bundled payment model.”


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