UnitedHealthcare introduces maternity care bundled payment program

UnitedHealthcare has a new bundled payment program for maternity care, marking the first time the insurer has offered the plan for its commercial book of business.

The program was introduced with two healthcare providers, Lifeline Medical Associates in New Jersey and the Privia Medical Group in Texas, and will expand to as many as 20 groups by the end of the year, the insurer said Thursday.

“We want people to have the information and the clinical resources they need [as well as] all the support we can give them so they have a healthy baby and a good outcome,” says Dr. Janice Huckaby, who leads UnitedHealthcare’s women’s health initiatives as a senior vice president and regional chief medical officer.

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The maternity bundled payment program reimburses a care provider or hospital for a specific episode of care — which could include prenatal, delivery and postpartum services — under a single fee or payment, UnitedHealthcare says. This is a shift from a fee-for-service structure, which would reimburse providers for a specific treatment, appointment or test, and typically generates multiple claims.

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“The maternity bundle that we have is going to be a retrospective bundle around obstetric care,” Huckaby says. “At the time of delivery [we] look back and see the services that were rendered.”

In addition to the bundled payment, UnitedHealthcare also offers a maternity care program to expectant mothers and their families. Included in the program is the UnitedHealthcare Healthy Pregnancy mobile app, which, among other features, connects employees with registered nurses, tracks the baby’s movements and provides access to benefit information. Eligible employers can offer these resources to their employees at no additional cost as part of their benefits plan.

Huckaby says the service is one of several the insurer offers to support pregnant women. For example, UnitedHealthcare also offers case management services to women with high risk pregnancies.

“The literature has shown that the best outcomes come when women are seen early in their pregnancies, and if they have any concurrent medical conditions, that those are addressed,” she says. “[Women should receive] recommended services and testing throughout their pregnancy.”

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UnitedHealthcare is not the only insurer to delve into bundled payment methods for maternity care. Humana launched bundled payment agreements with five OB-GYN practices across the U.S. last year. This is Humana’s second specialty-care payment model, following a total joint replacement episode-based model for Humana Medicare Advantage members, the insurer says in a statement.

“Humana is dedicated to working with OB-GYNs across the country to provide a better patient experience and improve patient outcomes, while also tackling the cost challenges inherent in perinatal care,” says Caraline Coats, vice president of Humana’s Provider Development Center of Excellence.

Employers should continue to seek ways to support their workers throughout pregnancy, Huckaby says. When women discover they are pregnant, they are often concerned about affording the cost of labor and delivery. It would be beneficial for employers to provide open lines of communication about the benefits that are offered to reduce this burden, she adds.

“I think the one thing employers could do is make sure that there are channels for employees or their spouses to receive specific information about their maternity benefit,” she says. “Showing up for care early is important, and anything that we can do to encourage women to do that in the first trimester will benefit everyone.”

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