Bundles are gaining traction in many specialties, often independent of nudges from CMS. Maternity bundles are one recent comer. Vanderbilt University Medical Center is completing year one of its commercial maternity bundle program, MyMaternityHealth, currently offered to employees of Vanderbilt and to the nearly 6,000 teachers at Metropolitan Nashville Public Schools (MNPS).
In general, contracts for bundled care with self-insured employers can yield a win for medical centers by raising volume, while aligning services with value. In turn, employers can stabilize spending and offer an appealing benefit to employees.
Thanks to zero out-of-pocket costs and a high-touch experience for the mothers, deliveries and patient satisfaction are up. Women in the program are receiving exceptional maternity care, including the clinical, financial and service aspects of their experience, according to C. J. Stimson, M.D., an assistant professor of urology at Vanderbilt and a senior advisor at the Center for Medicare and Medicaid Innovation. Stimson is the physician lead for Vanderbilt’s MyHealth Bundles program.
The Vanderbilt-MNPS contract covers all maternity-related services for eligible patients who enroll, at an agreed-upon fee to the school district. The plan diverges from most maternity bundles by encompassing year-long perinatal guidance and both provider and hospital clinical care, from conception through 12 weeks postpartum.
Erin Fairbrother, M.D., an obstetrician and clinical liaison for commercial maternity bundles at Vanderbilt, says bundles break down silos. “Instead of paying for separate services – such as radiology, surgery and anesthesiology – bundled payments encourage care coordination and better patient experiences,” she said.
From the start, the expectant mother is connected with a patient navigator, someone Liam Woodard, administrative manager of Vanderbilt’s commercial bundled payments, describes as “the glue that holds the program together, from an experience standpoint.” A patient navigator provides a touchstone, guiding the woman through education, setting up her appointments, and directly linking her with resources, such as childbirth classes or lactation assistance.
“Instead of paying for separate services – such as radiology, surgery and anesthesiology – bundled payments encourage care coordination and better patient experiences.”
Telehealth augments care accessibility. Patients in the bundle are provided a scale, a fetal heart rate Doppler and a blood pressure cuff, which allow the expectant mothers to share up-to-date vitals with their clinician during their prenatal telehealth visit. Enrollment in the bundle also triggers a series of emails containing education, ways to contact the navigators, and other resources specific to that bundle.
Multiple Financial Wins
Under MyMaternity Health, Vanderbilt delivered 33 percent more Vanderbilt and MNPS babies per month in 2020 than 2019, Stimson said, and patient satisfaction with their experience is high, based on a REDCap survey. “The obvious top benefit to the mother is a full-scale experience at a highly respected health care center,” Woodard said.
The benefits to Vanderbilt are more subtle. “The employer gets predictable costs,” Woodard said. “This is one more step in a longer-term evolution toward value-based care, a financial model that aligns with clinical incentives so everybody is working toward the same goal.”
C-section numbers at Vanderbilt have shown a slight downward trend since the early months of 2020, when the patient caseload included women already into their pregnancy. In fee-for-service systems, Stimson says the gray zone of potentially avoidable C-sections is rife with misaligned financial and clinical incentives. With maternity bundles, he says this concern is greatly reduced.
“This is one more step in a longer-term evolution toward value-based care.”
More Bundle Introductions
Vanderbilt plans to add the Baby + Co. birthing center option to the maternity bundle in 2022. MyMaternityHealth leads the way in bundle introductions at Vanderbilt: MyHearingHealth, MyWeightLossHealth, MyOrthoHealth and MySpineHealth are on deck for January 2021.
“Staggering the rollout of future bundles was really an exercise in learning,” Woodard said. “Most significantly, we’ve learned that while patients are price sensitive, the overriding feedback has been that they felt supported and guided through their experience in an otherwise tough to navigate, multifaceted health system. Those are messages that have definitely shaped our new bundle offerings.”