Much like the Accountable Care Act (ACA) debate in 2010, the current political debate over repealing and replacing the ACA is focused on coverage and cost. Aligning provider and payer incentives to reward value-based health care is key to addressing the escalating costs facing the healthcare industry and nation. We urge policymakers to accelerate value-based care by rewarding clinical quality and cost-efficiency in the U.S. healthcare system in order to reduce costs and drive innovation and care delivery transformation.
While President Trump and Congress consider plans to transform healthcare, we believe they don't have to look far for sensible models to control costs and improve quality. The ACA includes programs that drive value-based care, where doctors and hospitals profit from good outcomes rather than volume. This idea of value-based care predates the ACA in alternative payment models like bundled payments and global fees.
The premise behind bundled payments and global fees is to encapsulate a suite of procedures and services from one episode of care (like a knee replacement) into one fixed fee. These changes evolved as innovative insurance companies and providers realized that standardized protocols that control cost and optimize outcomes could be paid through a single reimbursement.
Maternity care stands out as an early adopter and great example of sensible payment reform from which we can learn. Maternity care providers long ago embraced payment mechanisms that value quality over volume. Their embrace of technology to positively impact care, manage risk and control cost are exemplary. The architects of the new “replacement” healthcare plan should study how maternity care is evolving to see how other service sectors can follow suit to make affordable care a reality.
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For more than 30 years across the United States, maternity care providers have received a flat fee from insurance companies or Medicaid for prenatal services (excluding hospitalization costs) for a routine pregnancy and delivery. This lump sum payment, known as a global fee, motivates maternity care providers to better manage costs while engaging patients so healthy mothers deliver healthy babies. Prenatal global fees are one of the earliest examples of value-based care.