Catalyst for Payment Reform recently released a study on a program called the South Carolina Birth Outcomes Initiative. CPR and South Carolina healthcare stakeholders — including the South Carolina Hospital Association, the South Carolina Department of Health and Human Services and BlueCross BlueShield South Carolina — wanted to find ways to improve the quality and affordability of healthcare when it came to early elective deliveries.
The groups decided to look at early elective deliveries and Caesarean sections because according to 2011 U.S. data, South Carolina had the fourth-highest percentage of babies born prematurely. Rates of both types of deliveries are rising across the country, but many studies have shown these types of births are not always scheduled with evidence-based decision making. According to leading obstetricians and gynecologists, early elective deliveries are associated with an increased risk of maternal and neonatal morbidity, and they cost significantly more, as well.
The BOI involved several different components, according to CPR’s report. Starting in 2011, 43 hospitals agreed to reduce early elective deliveries. In 2012, all claims related to early elective deliveries had to have a modifier so the state could trade rates more closely. Central to the initiative was payment reform. At the beginning of this year, the state Medicaid program and BCBS South Carolina, the largest commercial payer in the state, created a policy to stop paying providers for early elective deliveries prior to 39 weeks gestation.
Although the BOI is still in its infancy, the CPR shared some initial findings. Elective deliveries across all payers have decreased from 9.6 percent in the first quarter of 2011 to 5.2 percent in the first quarter of this year. The report also said more than $6 million has been saved in delivery expenses and neonatal intensive care unit expenses.
According to CPR’s report, the groups said the BOI “is a strong example of what committed individuals and organizations can do together to improve population health. However, any collaborative approach will enjoy greater success with a transparent structure, dedicated staff and reliable data. When private and public sector payers team up and align payment policy with desired health outcomes, such a collaborative approach is even stronger.”
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