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Transform Maternity Care

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With 3.95 million annual births and $111 billion spent by all payers for pregnancy-related conditions, maternity care represents the second-highest healthcare expenditure for employers in the United States and the largest for Medicaid. Despite this high spend, the U.S. experiences some of the worst maternal infant health outcomes in the developed world.

PBGH formed the Transform Maternity Care (TMC) program in 2012 to develop a maternity care system that embraces high value services, narrows variations in outcomes, and incentivizes safety throughout California and the U.S. The program emerged in response to PBGH Members’ dissatisfaction with the current state of maternity care and desire to better support the wellbeing of their employees.

To accomplish our mission, the TMC developed programming in four strategic priority areas. They include:

1. Reduce C-sections

Although C-sections are clinically recommended for 10% to 20% of births, nearly 32% of women deliver by C-section. The large variations in C-section rates among hospitals in a small geography signals that a women’s risk in large part depends on which hospital she decides to have her baby.

To understand what contributes to high and variable C-section rates, PBGH led a pilot that demonstrated a significant reduction in C-section rates in three hospitals using data and payment reform in nine months. The pilot has served as the foundation for California efforts to reduce hospital C-section rates. TMC is working to spread this model for C-section reduction nationally with purchaser coalitions outside California.

2. Expand Use of Nurse-Midwives

Despite the established savings, safety and quality of midwife-led care, hospitals and health systems are slow to integrate their services. With less than 9% of births attended by a CNM, California has many opportunities to increase the number of pregnant women receiving CNM-led care.

With guidance from expert interviews, PBGH developed a Blueprint for Action that outlines five essential strategies to increase access to midwifery services. In 2018, TMC executed on the first two strategies and released two tools: a business planning tool and a “How to Successfully Integrate Midwives into Your Practice” guide. Together, these tools equip physician practices and hospitals to make the case for integrating nurse-midwives and implementing the midwifery model of care.

3. Spread Value Based Payment

Value-based payment seeks to change reimbursement incentives for hospitals and physicians to reward quality over quantity. To increase value in maternity care, payment reform needs to improve quality, reduce costs, or both.

Purchasers are essential to advancing value-based payment reform efforts. To help guide purchaser action, PBGH released an Employer Action Guide and a California Issue Brief that define what employers should do to promote adoption of value-based payment reforms. PBGH also convened payers and multi-stakeholder groups to advocate for payment changes that move the system toward prospective bundled payments.

4. Engage Patients

Pregnancy and childbirth serve as most women’s first in-depth experience with the health care system. Yet, we offer no way for pregnant women to provide feedback about the quality of their maternity care experiences.

To support the dissemination of effective pregnancy health information, PBGH conducted a market assessment to develop an employer implementation guide of maternity focused patient engagement tools. PBGH is currently seeking opportunities to develop surveys and platforms that measure and report a woman's experience with maternity care services.

For more information contact:

Blair Dudley
Senior Manager, Transform Maternity Care


Last Updated May 2, 2019