From Childbirth Connection

The Cost of Having a Baby in the United States

Maureen P. Corry, MPH

Disclosures

May 09, 2013

In This Article

Introduction

Background

Truven Health Analytics recently issued a major new report, The Cost of Having a Baby in the United States. With permission from Truven, Medscape is reproducing several items from the report.

First, a Foreword from leaders of the 3 organizations that commissioned the report -- Childbirth Connection, Catalyst for Payment Reform, and Center for Healthcare Quality and Payment Reform -- identifies significant opportunities to improve the quality, health outcomes, and value of maternity care and the role of payment reform. Second, the report's Executive Summary provides an overview of Key Findings. Finally, Medscape reproduces the report's summary section, "Total Maternity Care Cost Analyses," including a series of summary tables and figures.

The full report includes a discussion of the methodology, separate maternal and newborn cost analyses, and extensive supplementary data in appendices. It is available on the Websites of the sponsoring organizations, including Childbirth Connection's Transforming Maternity Care Website.

Foreword

Better care, better outcomes, and lower costs in health care are all possible through use of innovative delivery systems, supported by value-based payment systems and effective performance measurement. One of the greatest opportunities for improving health care value is in maternity care, which impacts everyone at the beginning of life and about 85% of women during one or more episodes of care. Most childbearing women are healthy, have healthy fetuses, and have reason to expect an uncomplicated birth, yet routine maternity care is technology-intensive and expensive: combined maternal and newborn care is the most common and costly type of hospital care for all payers, private payers, and Medicaid. Childbirth Connection, Catalyst for Payment Reform, and the Center for Healthcare Quality and Payment Reform commissioned this report to focus the attention of all stakeholders on the need to better align maternity care payment and quality.

Significant improvements in quality and savings in costs can be achieved by reducing unwarranted practice variation and the overuse of some interventions and underuse of others. High-performing maternity care providers and settings and the women and families they serve demonstrate the potential for dramatic improvement in care, outcomes, and value relative to usual care and population norms. Childbirth Connection's multi-stakeholder, deliberative Transforming Maternity Care developed two direct-setting consensus reports: 2020 Vision for a High-Quality, High-Value Maternity Care System and a Blueprint for Action to chart the path toward such a system. From its inception, the project's key informants and Steering Committee members understood that a multi-faceted strategy, including payment reform, changes in benefit structures, public education, and provider engagement, is essential for successfully driving needed improvement. This new report on the Cost of Having a Baby in the United States[1] clarifies that significant savings can be achieved by advancing priority Blueprint recommendations.

Catalyst for Payment Reform (CPR), a nationwide nonprofit coalition of large national employers and public payers, including several state Medicaid agencies, understands that maternity care is in need of significant payment reform, both to remove the perverse incentives for unnecessary intervention in labor and delivery and to increase incentives for better adherence to rigorous clinical guidelines. To help purchasers work with health plans towards this goal, CPR created its Maternity Care Payment Reform Toolkit, available to all stakeholders.

The Center for Healthcare Quality and Payment Reform (CHQPR) has been working since 2009 to educate physicians, hospitals, health plans, employers, consumers, and policy makers about the barriers to higher quality, more affordable health care created by current health care payment and delivery systems and ways to overcome those barriers. CHQPR understands that one of the best opportunities for making health care more affordable and improving the health status of the public is through improving the way maternity care is delivered in America. More information and resources about ways to improve payment and delivery of maternity care are available on the CHQPR website.

The MarketScan Commercial and Medicaid databases provided a unique opportunity to understand levels of charges and payments for maternal and newborn care in 2010. This report offers detailed breakdowns by Commercial and Medicaid payers, primary insurer versus secondary insurer and out-of-pocket payment sources, vaginal and cesarean birth, type of service, and phase of care. Special analyses investigate variation in maternal charges and payments across five selected states, costs of care for newborns with stays in neonatal intensive care units, and the increase in payments for maternal care from 2004 to 2010.

Maureen P. Corry, Executive Director, Childbirth Connection

Suzanne F. Delbanco, Executive Director, Catalyst for Payment Reform

Harold D. Miller, Executive Director, Center for Healthcare Quality and Payment Reform

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