As Skepticism for Value-Based Care Increases, Here’s a Practical, Common Sense Case for a Value-Based Approach in Maternal Health

After years of relentless buzz and momentum, it appears we are entering an age of skepticism for value-based care. Some experts are even calling for a “time out” for value-based initiatives, claiming we haven’t seen these models live up to their hype. While it’s obviously good to have a critical eye for what’s worked and what hasn’t been successful, we need to be careful here. Wielding these types of verdicts could impede the progress of much needed transformation at an incredibly pivotal time for our healthcare system. 

While value-based care is not a panacea as some initially proclaimed, I believe it is the future. It is our only reasonable choice. The best, and only, way we will heal healthcare is by aggressively scaling value-based models. Particularly for high opportunity areas such as maternal health. 

Can value-based care be designed and executed poorly? Of course it can. Are we currently painting a broad brush when we evaluate success of value-based care? I think we are. Just as terms like “digital health” can mean a million things, there are many different models for value-based care, and they aren’t all created equally.   

Whether or not you believe we have fully proven the ultimate “value” of value-based care, there have been enough wins and losses in this arena to guide us as we move forward. Existing models might not be perfect, but value-based care will work -- IF. If you thoughtfully design it. If stakeholders fully embrace it and actively participate in design and delivery. If you have the right data and tools at the ready. If you execute, at scale. And if you can prove the value you create through measurement. 

It makes sense at a very foundational level that economic models and care models must align to fuel the change we need to see. There is no more money available to pay for the deployment of team-based care, to complete SDoH screenings, to create better access to behavioral health and so on. We have to align, or we won’t get there.

To be fair and balanced, our industry is very much shackled by the status quo, and we can’t expect seismic shifts to occur overnight. In fact, most of the companies who have enjoyed success with value-based initiatives have actually relied on fee-for-service funding in the short term as they expand their value-based care infrastructure. In essence, they are using the current payment model as a funding bridge to value-based transformation.  

There is a difference between taking a thoughtful, incremental  approach and getting stuck in pilot mode. Pilots are dart throws at worst and isolated success at best. What I’m advocating for is laying a foundation for scale and moving at the speed of what’s possible in the short term with a focus on the end goal. In other words, laying the tracks for the value-based train that will transport us into a new, and better, day for healthcare. 

We are seeing progress in pockets of the country when it comes to advancing value-based care for maternity. 

Several states are embracing value-based care as a strategy for Medicaid beneficiaries.

Vanderbilt University Medical Center has generated positive outcomes with its maternity bundle, aimed at regional employers. 

The Health Transformation Consortium recently announced a strategic partnership with Wildflower and several leading OB-GYN practices to create a value-based model for the state of New Jersey. 

It’s time to scale those efforts more broadly. 

I’d like to wrap up with an exercise to demonstrate the practical, common sense case for value-based care in maternal health. Let’s answer the following questions one by one and then determine what that suggests about the prospects of deploying a value-based model for maternity care. 

>>> Have we identified the main drivers of poor outcomes and the specific conditions that most negatively impact maternal health? 

>>> Do we as an industry have access to solutions that leverage technology, data and virtual tools to directly address these challenges?

>>> Do providers need help adopting and leveraging these tools to improve patient care?

>>> Would appropriately leveraging the available solutions, aimed at the right challenge lead to better support for patients?

>>> Additionally, if all stakeholders collaborated more effectively and worked together, would that improve access, equity, experience and outcomes in maternal health?

>>> Would the outcomes generated by leveraging the right tools and better stakeholder collaboration be achieved at a lower overall cost to the system? 

>>> Do we need to change the current funding model in order to activate this type of approach?

The answer to all of these questions? YES! Emphatically. So if you put all these pieces together, the only logical question is not “if”, but “when” we will widely deploy value-based models to transform the delivery and funding of maternity care in this country.