The nation's largest insurer, UnitedHealthcare, has launched a nationwide bundled-payment model for maternity care, closely following the lead of Cigna and Humana, which have had the option since early last year.
The Minnetonka, Minn.-based payer announced Thursday that its new bundled-payment program already has two provider groups participating, and plans to add as many as 20 by year-end.
Similar to other insurers, UnitedHealthcare saw an opportunity to reduce costs and improve quality for pregnancy and childbirth services, which are the most common reasons for hospitalizations in the U.S. In 2018, UnitedHealthcare received about 324,000 maternity claims, accounting for nearly 1 out of 10 U.S. births, according to Dr. Janice Huckaby, senior vice president of UnitedHealthcare's women's health initiatives.
Research also shows there is significant variation in the cost of maternity-care services, which makes it an ideal service to be bundled.
"Obviously, this is a hugely important opportunity for us," Huckaby said.
The bundle, which is paid retrospectively, is for commercially insured UnitedHealthcare members who don't have other medically complex conditions that would make the pregnancy risky. The bundle is triggered when the member is admitted to a hospital for labor but will also look at care provided during and after pregnancy.
Providers will receive bonuses if they improve on certain quality measures and decrease costs compared to other providers in their market. Some of the quality measures UnitedHealthcare will be looking at are frequency of prenatal visits and timeliness of postpartum care.
The providers won't be on the hook for losses if they fail to meet targets, but Huckaby said UnitedHealthcare will consider it as providers get used to the model.
Humana launched its maternity-care bundle in April 2018 and Cigna announced its program in January 2018. Horizon Blue Cross and Blue Shield of New Jersey also has a program, and some state Medicaid agencies have adopted the models.
The bundle options from insurers come as providers deal with a high maternal mortality rate. A report this week from the Centers for Disease Control and Prevention found that about 700 women in the U.S. die each year due to pregnancy- or birth-related complications up to a year after delivery. Heart disease, stroke, severe bleeding, high blood pressure and infections are among the causes of death.
"We know from literature and common sense that prenatal care is essential to get the kind of health outcomes … we want," Huckaby said.
