Delivery of Care

A maternity bundle of joy, better care and predictable costs

Care New England, Blue Cross & Blue Shield of Rhode Island introduce a new bundled approach to delivery, integrated care, and payments

Women & Infants Hospital website

From the Women & Infants Hospital website, an image introducing maternity care. The hospital is launching an innovative bundling of care in partnership with Blue Cross & Blue Shield of Rhode Island to improve the quality of care and reduce costs.

By Richard Asinof
Posted 11/17/14
The new model of bundled care for maternity, being introduced as a part of a strategic partnership between Blue Cross and Care New England, marks the continuing journey away from fee-for-service in Rhode Island and an evolution toward patient-centric, integrated care models.
What are the metrics that will measure the outcomes from the program? How transparent will the outcomes be? What role will patients and families play in the development of the new care model, other than as consumers? What kinds of care coordination can be improved for women who are uninsured and part of the safety net served by Women & Infants? How will this new model of care resonate with ob-gyn providers?
When Thundermist created a partnership with Women & Infants to have its maternity patients deliver there, rather than at Landmark Medical Center, it developed a transportation program to ensure that pregnant mothers could arrive at Women & Infants. Would a similar transportation arrangement with other community health centers and with patients be the kind of investment that could be supported and encouraged as part of the new model of care – a new kind of Uber pregnancy service? Are there ways that Blue Cross and Care New England could work cooperatively with nutrition outreach to provide support for expectant mothers as part of the bundled approach?

PROVIDENCE – A new payment model, coupled with a new integrated, family-centric care model, promises to change the way that babies are delivered and cared for at Women & Infants Hospital, thanks to an innovative collaboration between Care New England and Blue Cross & Blue Shield of Rhode Island.

The goal will be to deliver the best end-to-end experience for mothers giving birth, from the first prenatal physician visit, through delivery at the hospital, to a safe and comfortable transition home following the baby’s birth, according to Dennis Keefe, president and CEO of Care New England.

“It is our hope that this will make Rhode Island a national leader in defining and delivering maternity care excellence,” said Dr. Maureen G. Phipps, chief of Obstetrics and Gynecology at Women & Infants.

Phase I of the program, which is scheduled to begin in January of 2015, will focus on the family’s experience at Women & Infants Hospital at the time of delivery and for six weeks following delivery, according to hospital and insurance officials.

It will include:
• An increased level of service in the transition from hospital to home, post-delivery nursing visits;

• More intensive focus on support of the new family unit, such as family planning and depression screening, and

• Education and screening for long-term risks associated with gestational diabetes.

Phase II, to be introduced later in 2015, will focus on developing evidence-based protocols to manage prenatal care.

In the new care model, the patient is at the center, according to Peter Andruszkiewicz, president and CEO at Blue Cross & Blue Shield of Rhode Island. “The care teams are coordinated and far more integrated, and payment arrangements provide financial incentives for the health of populations,” he said in a news release announcing the new program.

A total of 8,426 infants were delivered in FY 2014 at Women & Infants, more than 70 percent of all births in Rhode Island. There were 5,813 vaginal births and 2,613 births by Caesarian section, according to hospital officials.

The new program is an outgrowth of a strategic collaboration between the state’s second largest hospital system and the state’s largest commercial health insurer. The details of the innovative, bundled approach to maternity care was developed in a series of ongoing collaborative discussions involving physicians, hospital administrators and insurance officials.

ConvergenceRI spoke recently with Dr. Ray Powrie, senior vice president for Quality and Clinical Effectiveness at Care New England and acting chief of the Department of Medicine at Women & Infants, to learn more details about the innovative new program.

ConvergenceRI: What was the rationale behind launching this program?

POWRIE: Maternity costs have risen at a faster pace for the past 20 years. We’re investing more in providing maternity care, but we actually haven’t seen a drop off in mortality and morbidity. The U.S. is not among the top five countries in maternity outcomes. People were wondering: What are we doing wrong? Why are costs going up and outcome not improving?

We have been working with Blue Cross for the last year and a half to redesign aspects of maternity care to drive quality and actually drop costs. The basic premise is that we can do a better job and spend a lot less.

ConvergenceRI: What are the incentives for physicians and nurse midwives and patients to participate in the bundled approach?

POWRIE: We are setting a national trend, with a very innovative program, to deliver the highest quality of care at the lowest cost. Other providers, other insurers have begun to ask: can they do a bundle, too?

We are investing an incredible amount of time and resources to get this right. We have a three-hour meeting almost every week, rethinking about how we deliver our care.

The basic premise of any bundle to is deliver really high quality care, with better outcomes. In this case, we have a variety of promises that will make to our patients, commitments that we will track. The benefits that go back to the patient are higher quality and lower costs, with people’s health insurance premiums going down.

ConvergenceRI: How do the actual costs break down? Can you share the numbers?
POWRIE:
The costs are broken down as single costs paid by Blue Cross to the hospital for the care of the delivery of the infant and six weeks following the delivery. There is a single cost for normal, uncomplicated deliveries and complicated deliveries.

Our hope is that by delivering even better quality care, we can prevent some of the births that are treated by the Neonatal Intensive Care Unit. If our Neonatal Intensive Care Unit is less busy, if we can take better care of the mother and child, that’s one of our goals.

We also want to decrease the number of unnecessary C-sections, so that babies are carried to term, if possible.

ConvergenceRI: How much of improving maternity care outcomes is related to getting early prenatal care and supporting better nutrition for expectant mothers?
POWRIE:
There’s no question, in much of the world, that’s an important factor in changing outcomes, getting women in earlier, and making sure that they have the proper interventions.
For some of the [patients] that we see, it’s still an important issue: to plan pregnancies, to space their pregnancies out. We do better than many states.

ConvergenceRI: How do the maternity services at Kent Hospital and Memorial Hospital fit into the equation?
POWRIE:
It is part of Dennis Keefe’s vision to build a fully integrated health care system, where we can offer the services at the highest levels across our hospital system. Women & Infants is a national leader, but the obstetrics programs at Kent and Memorial are important to us, and we believe in trying to pick up best practices and contributions from all parts of the system.

It is not competition, but rather, collaboration, with the expertise at Women & Infants enhancing the level of care at the other hospitals.

ConvergenceRI: How does the nurse-midwife program fit into the new bundled care approach?

POWRIE: We will continue to embrace the model of midwives as a critical component of care. It results in very high quality, at lower costs. Midwives and obstetricians working together is the best model of care.

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