Bundled care for self-insured employers is gaining traction in many specialties, often independent of nudges from CMS.
One compelling reason is that they help medical centers raise volume while aligning services with value. Results from the first two years of Vanderbilt University Medical Center’s MyMaternityHealth bundle program show higher patient and employer satisfaction, as well.
MyMaterintyHealth is being offered to the nearly 20,000 employees of Vanderbilt University Medical Center and 6,000 Metropolitan Nashville Public Schools (MNPS) teachers.
“Instead of paying for separate services – such as radiology, surgery and anesthesiology – bundled payments encourage care coordination and better patient experiences.”
With zero out-of-pocket costs and a high-touch experience for the mothers, both deliveries and patient satisfaction are up. Women in the program are receiving exceptional maternity care with the clinical financial and service aspects of their experience, according to C. J. Stimson, M.D., an assistant professor of urology at Vanderbilt and senior advisor to the Vanderbilt Health System CEO. Stimson is the physician lead for Vanderbilt’s MyHealth Bundles program.
The bundle contract between Vanderbilt and the Nashville school system covers all maternity-related services for eligible patients who enroll at an agreed-upon fee. 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 who serves as a touchstone, guiding the woman through education options, setting up her appointments, and directly linking her with resources, such as childbirth classes or lactation assistance.
“The navigator is the glue that holds the program together, from an experience standpoint,” said Liam Woodard, assistant director of operations for Vanderbilt’s commercial bundled payments.
“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.”
Telehealth is available to augment accessibility to care. Patients in the bundle also 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 visits. Enrollment in the bundle also triggers a series of emails containing educational materials, contact information for the navigators, and other resources specific to that bundle.
As of November 17, 2021, Woodard says there had been 688 deliveries covered by MyMaternityHealth.
Reports of satisfaction among patients is high, based on REDCap surveys. Since the inception of MyMaternityHealth, Vanderbilt has logged NET Promoter Scores in the 90th percentile, standing in stark contrast to average NET Promoter scores for health care, which Woodard says usually run in the 20th percentile. These scores are based on responses of patients when asked about their willingness to recommend Vanderbilt to family and friends for maternity care.
“The obvious top benefit to the mother is a full-scale experience at a highly respected health care center,” Woodard said. “The employer gets predictable costs.”
Some of the benefits to Vanderbilt are more nuanced.
“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,” Woodard said.
Stimson said the medical center’s C-section numbers have shown a slight downward trend since the early months of 2020, when the MyMaternityHealth 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.
More Bundle Introductions
MyMaternityHealth has led the way in bundle introductions at Vanderbilt. MyHearingHealth, MyWeightLossHealth, MyOrthoHealth and MySpineHealth were brought into play in January 2021.
“We’re also adding medical weight loss to the MyWeightLossHealth Bundle, and both osteoarthritis and shoulder pain to the MyOrthoHealth Bundles, with those additions launching on January 1, 2022,” Woodard said.
The staggered rollout of bundles has allowed Vanderbilt to learn from its experience, he 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 messages have definitely shaped our new bundle offerings.