Value-Based Care is Currently a Boy’s Club. We Need to Make Sure Women Can Join the Party.

Value-Based Care is Currently a Boy’s Club. We Need to Make Sure Women Can Join the Party.

Value-Based Care, Maternity, Health Innovation, Mission

Women make up half of the U.S. population. They are responsible for 80 percent of healthcare decisions and spending. And they are being systematically eliminated from one of the most promising trends in healthcare.

I’m speaking of value-based care, a model of healthcare that aspires to align how providers are paid with the outcomes, quality and total care costs associated with their patients. This model has the promise to transform the US healthcare delivery system from a fee-for-service treadmill to a model where providers are rewarded for delivering the best care possible at the optimal cost.

When you look at women’s health, the case for value-based care is particularly compelling. Take maternity care as an example. Currently, providers are not paid to avoid unnecessary procedures. They aren’t paid to survey for social determinants of health and non-clinical factors that impact outcomes and cost. They aren’t funded to install programs that ensure all patients receive equitable care regardless of race or ethnicity. As a result, we have the highest maternal mortality rates in the developed world, despite paying the most for the care itself.  

Value-based care for maternal and newborn health has the potential to literally save lives and bend these metrics in the right direction. And yet, we routinely find that in most geographies less than 10 percent of OB episodes are being funded by a value-based model.

The adoption of these models is slow in part due to the administrative complexities involved for payers, and the lack of tools available to support providers in transforming the way they deliver care. A worsening shortage of OB/GYNs is making the adoption of value-based care even more challenging. None of this changes the truth: Value-based care is key to meaningfully improving maternal health outcomes in this country. 

The case for value-based care that effectively engages women is not limited to pregnancy, however. The case is equally strong for engaging women in a holistic value-based model. Women tend to cost more than men over the course of their lives, and they bear additional emotional stressors, such as caregiving. But the way value-based care is currently constructed, women are largely left out of the equation.

The two most common types of value-based models are episode-based and total cost of care based. We have already discussed the most common episode-based scenario for women, which is pregnancy. Total cost of care models, on the other hand, typically encompass all the costs associated with patients who are receiving care from a specific health system or network of providers. This includes both routine and episodic care.  

With total cost of care models, the OB episode is often included as a service in the calculation and represents up to 10 percent of the total medical costs in a typical commercial population.  However, in these models, the OB episode is typically not measured separately, and OB providers may not participate in savings. This means such modes don’t optimize for improvements in pregnancy care.  

Additionally, many total cost of care models use a patient’s primary care provider as a proxy for inclusion in the program.  We know that up to nearly half of women do not have a PCP that they see regularly. This means that half of women will not actively be part of a value-based model for primary care. Using a PCP relationship as the proxy for value-based care means that either we are excluding a large percentage of women from the process, or we are expecting them to fundamentally shift where they are receiving care. A better path forward would be to consider OBs in the design of value-based models while also ensuring they have the appropriate tools to holistically support their patients in such an environment. 

Value-based care will work. It is our best shot at saving a dysfunctional system and lifting healthcare outcomes from the abyss. This is specifically true for women, and their healthcare needs. But we must ensure that women are being addressed, and that we are inviting them to the party. The current under-representation of women in value-based models is concerning and must change. The future of value-based care depends on it.


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5 Keys to Success for Value-Based Maternity Care

Is your organization ready for change? Value-based care offers obvious potential for improving maternal health outcomes. However, the transition from fee-for-service has proven to be extremely difficult. It’s a complex ask of payers and providers to collapse existing silos of care and to transform existing payment models to properly align incentives. Not to mention the investment that is required in the form of new tools and technologies to manage data, engage differently with patients and better coordinate care.

In this ebook, we examine the five keys to success for constructing an effective value-based care model for maternity. The shift toward value is intensifying, and the maternity episode is taking center stage as both an opportunity and an imperative to address our current maternal health crisis.