New Payment Models for Improving Maternal and Infant Health and Health Care

  A Convening Hosted by NEHI in Partnership with Merck for Mothers.

The Network for Excellence in Health Innovation (NEHI) hosted a stakeholder convening in partnership with Merck for Mothers. More than 75 participants explored a wide range of maternal and infant health and healthcare issues on December 11, 2018, at the Kaiser Permanente Center for Total Health in Washington, DC. Individuals and organizations with either experience in, or familiarity with, new maternal health payment models and/or maternal health quality and safety initiatives, came together to discuss new payment models to reduce rates of maternal and infant mortality and support optimal maternal and infant health outcomes in the United States. Rather than prepared presentations, the convening consisted of discussion-based modules that were launched by a series of "thought starters."

These "thought starters" advanced the conversation by addressing how the United States health and maternity care is afflicted with problems. They discussed which evidence-based practices have been shown to improve quality, safety, and outcomes and how these practices relate to payment. Merck for Mothers has illustrated many important steps to make childbirth safer using evidence-based tools and practices to prevent and treat leading causes of maternal death. Many women who become pregnant in the U.S. are already in a state of poor health, which often contributes to the leading causes of maternal death (hemorrhage, pregnancy-related hypertensive disorders, and infection). 

Merck for Mothers asked NEHI to explore potential for new payment models, as payment has long been identified as a key contributing factor to improving care and eliminating unwarranted disparities in care and outcomes. Current payment approaches are far from the only problem affecting maternal and infant health, but convening participants noted new payment models, by contrast, could possibly help to ameliorate a variety of problems:

  • Over-medicalization of pregnancy and deliveries 
  • Pricing and payment variation
  • Under recognition of women's varying preferences and lack of shared decision making
  • Need for customization
  •  Over-utilization and under-utilization of services
  • Disparities in care, morbidity and mortality
  • Dearth of outcomes
  • Return on investment considerations
  • Separate silos for maternal and infant care

Throughout the discussion, more "thought starters" discussed how these opportunities and ideas listed are multiple examples of efforts toward improving quality and safety of maternal and infant care. 

"We need to lead with the care models that work"

Convening participant 

Convening participants raised ideas and identified various high-priority opportunities to advance maternal and infant health and health care by outlining a road map. Priorities identified were:

  • Identify and share optimal care delivery models and practices that include both mother and infant, that produce best outcomes for both, and that promulgate optimal care pathways
  • Create new payment models that will support the optimal care pathways
  • Establish and/or maintain regional quality and safety collaborative to continue to improve care, gather, and analyze relevant data
  • Work with provider groups and payers to expand care teams
  • Establish a national repository of best practices/promising practices
  • Develop new quality metrics for maternal and infant health, as there is a paucity of widely used measures presently
  • Promote a maternal and infant health "moonshot" incorporating the steps identified above

A collaborative involving women, families, the public health community, organizations, public and private payers and purchasers, healthcare providers, hospitals and health systems, advocates, and federal state and local policy players needs to be assembled in order to improve maternal and infant heath and health care. Acting on these important changes in payment models and public policy will provide support to optimal and improved care. Maternal and infant health needs to become a higher national priority. 

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This information was taken from the meeting summary by Susan Dentzer, former president and CEO of the Network for Excellence in Health Innovation (NEHI), and Valerie Fleishman, executive director of NEHI. Research assistance was provided by Yaminah Romulus, health policy and program associate at NEHI. NEHI is grateful to Merck for Mothers for its support of the convening.

For more details on the meeting, download the PDF. 

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Tuesday, March 26, 2019