Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing

Avery, Melissa D.; Bell, Amy D.; Bingham, Debra; Corry, Maureen P.; Delbanco, Suzanne; Gullo, Susan; Ivory, Catherine H.; Jennings, John C.; Kennedy, Holly Powell; Kozhimannil, Katy B.; Leeman, Lawrence; Lothian, Judith A.; Miller, Harold D.; Romano, Amy M.; Sakala, Carol; Shah, Neel

doi:10.1891/1058-1243.27.3.130

Cited by 41 publications

(79 citation statements)

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“…This requires a shift away from payment for procedures, which is known to drive cost and decrease quality. Steps toward the transformation of the current system outlined in the Blueprint for Advancing High‐Value Maternity Care through Physiologic Childbearing include improving access to birth center care by reducing various regulatory barriers . Developing sustainable reimbursement by Medicaid for time‐intensive care is recommended.…”

Section: Discussionmentioning

confidence: 99%

Strong Start in birth centers: Socio‐demographic characteristics, care processes, and outcomes for mothers and newborns

Alliman

Stapleton²,

Wright³

et al. 2019

Birth

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Background A recent Center for Medicare and Medicaid Innovation report evaluated the four‐year Strong Start for Mothers and Newborns Initiative, which sought to improve maternal and newborn outcomes through exploration of three enhanced, evidence‐based care models. This paper reports the socio‐demographic characteristics, care processes, and outcomes for mothers and newborns engaged in care with American Association of Birth Centers (AABC) sites. Methods The authors examined data for 6424 Medicaid or Children's Health Insurance Program (CHIP) beneficiaries in birth center care who gave birth between 2013 and 2017. Using data from the AABC Perinatal Data Registry™, descriptive statistics were used to evaluate socio‐behavioral and medical risks, and core perinatal quality outcomes. Comparisons are made between outcomes in the AABC sample and national data during the study period. Results Childbearing mothers enrolled at AABC sites had diverse socio‐behavioral risk factors similar to the national profile. The AABC sites exceeded national quality benchmarks for low birthweight (3.28%), preterm birth (4.42%), and primary cesarean birth (8.56%). Racial disparities in perinatal indicators were present within the Strong Start sample; however, they were at narrower margins than in national data. The enhanced model of care was notable for use of midwifery‐led prenatal, labor, and birth care and decreased hospital admission. Conclusions Birth center care improves population health, patient experience, and value. The model demonstrates the potential to decrease racial disparity and improve population health. Reduction of regulatory barriers and implementation of sustainable reimbursement are warranted to move the model to scale for Medicaid beneficiaries nationwide.

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Section: Discussionmentioning

confidence: 99%

Strong Start in birth centers: Socio‐demographic characteristics, care processes, and outcomes for mothers and newborns

Alliman

Stapleton²,

Wright³

et al. 2019

Birth

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“…56,57 For example, the recent Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing has an entire section devoted to payment reform and innovation in maternity care, highlighting the promise of bundled payments, shared savings, and episode-based care. 58 As a clearly defined and time-limited health condition, pregnancy and childbirth care may be particularly well-suited for bundled payment models, which associate a global fee with provision of a set of services. 59 Given this study's findings about the potential cost savings associated with a shift toward midwife-led care, the inclusion of midwives as key members of clinical care teams in settings using bundled payments may improve the prospects for this type of payment innovation, which has already shown promise in health systems such as Geisinger.…”

Section: Discussionmentioning

confidence: 99%

Midwife‐led care and obstetrician‐led care for low‐risk pregnancies: A cost comparison

Attanasio

Alarid‐Escudero

Kozhimannil

2019

Birth

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Objective Low‐risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife‐led care vs obstetrician‐led care for low‐risk pregnancies using a decision‐analytic approach. Methods We developed a decision‐analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife‐led vs obstetrician‐led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011‐2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments. Results The costs of childbirth for low‐risk women with midwife‐led care were, on average, $2262 less than births to low‐risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife‐led care, compared with obstetrician‐led care. Across the population of US women with low‐risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife‐led vs obstetrician‐led care) and fewer episiotomies (170 504 vs 415 686, for midwife‐led vs obstetrician‐led care). Conclusions A shift from obstetrician‐led care to midwife‐led care for low‐risk pregnancies could be cost saving.

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“…The recently published Blueprint for Advancing High-Value Maternity Care through Physiologic Childbearing has identified IPE for perinatal care professionals as one of 6 recommended strategies to improving perinatal care in the United States. 13 In 2010, ACOG and ACNM partnered as part of the ACOG President's Issue of the Year in a competitive call for papers describing examples of successful collaborative practice between ACNM member midwives and ACOG Fellows. 14 The initiative resulted in submission of 60 manuscripts jointly authored by midwives and obstetrician-gynecologists; the papers were reviewed by a team of ACNM member midwives and ACOG Fellows.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse‐Midwives and American College of Obstetricians and Gynecologists Collaboration

Avery

Jennings

Germano

et al. 2020

J Midwife Womens Health

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Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse‐Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team‐Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient‐centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.

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Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing

Cited by 41 publications

References 0 publications

Strong Start in birth centers: Socio‐demographic characteristics, care processes, and outcomes for mothers and newborns

Strong Start in birth centers: Socio‐demographic characteristics, care processes, and outcomes for mothers and newborns

Midwife‐led care and obstetrician‐led care for low‐risk pregnancies: A cost comparison

Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse‐Midwives and American College of Obstetricians and Gynecologists Collaboration

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