Successful Design of an Outcome-Based Payment Model for Maternity Care

An integrated maternity care organization, involving primary and secondary maternity care providers, working with the insurer, redesigned two maternity care pathways — one for gestational diabetes mellitus and one for pain relief during labor — to develop an outcome-based shared-savings model, building on an existing bundled-payment arrangement. The care pathways were evaluated using time-driven activity-based costing, process indicators, clinical outcomes, and patient-reported outcomes. The new pathway for gestational diabetes mellitus led to fewer referrals to internal medicine, reduced need for insulin therapy, improved patient-reported experiences, and substantial cost savings. The new pathway for pain relief led to a reduction in obstetrician-led pain relief use, but clinical outcomes, patient-reported experiences, and costs remained largely unchanged. Given the savings achieved in the diabetes pathway, a shared-savings model was developed, with the allocation of savings based on meeting an outcome-based benchmark. This model demonstrates how outcomes can be incorporated into payment models to reward value-improving behavior. Despite the successful development of the model, there were significant challenges, including aligning cost data with existing reimbursement structures. Nonetheless, the collaboration built a foundation for future innovations in value-based maternity care delivery and payment reform.