By Molly Giammarco, MPP

No one can argue that health care costs are out of control and the maternity care system is broken - providing more "care" at with ever increasing costs, with an outcome of poor results. Today, Molly Giammarco, Lamaze International's Senior Manager of Goverment Relations discusses a new concept in maternity care payments and how Lamaze has lobbied for quality childbirth education to be included in the bundled care. - Sharon Muza, Community Manager, Science & Sensibility

In an effort to curb healthcare costs and increase quality, providers, payers, and policymakers are looking toward alternative payment models that realize a more effective and efficient healthcare delivery system. These payment models, such as bundled payments, streamline a compartmentalized system by presetting a reimbursement rate for all providers who take part in a specific episode of care. Early bundled payment pilots have focused on orthopaedic procedures, and as the concept establishes footing, it will expand to maternity care episodes (prenatal care, labor & birth, postpartum care).

The Health Care Payment Learning & Action Network's (LAN) Clinical Episode Payment (CEP) for maternity care is one such example of this expansion. In April 2016, the LAN CEP Work Group released a draft whitepaper, Accelerating and Aligning Clinical Episode Payment Models: Maternity Care for public comment. This draft detailed a payment model that encompassed prenatal, labor & birth, and postpartum care for low-risk pregnancies.

Lamaze International was pleased that the CEP Work Group included education as a prenatal component and took the opportunity to provide additional guidance on how the proposed model should explicitly incorporate evidence-based childbirth education. In doing so, Lamaze provided three recommendations to the CEP Work Group: 1) Explicitly define childbirth education; 2) Measure the effect that specific interventions have within the CEP; and 3) Define maternal and childbirth outcomes and measures.

1) Explicitly Define Childbirth Education: As certified childbirth educators, you are keenly aware that the term, childbirth education, encompasses everything from a pamphlet and a five-minute discussion at the doctor's office to comprehensive courses that use an evidence-based curriculum. Lamaze recommended that the CEP Work Group explicitly define childbirth education as "a comprehensive, evidence-based curriculum taught by childbirth educators who are certified by a National Commission for Certifying Agencies-Accredited certification body." Establishing such a definition would set a standard for childbirth education, which would ensure that resources allocated toward prenatal education are wisely invested-and yield positive results.

2) Develop a Plan for Measuring the Effect that Specific Interventions have Within the CEP Work Group: By grouping multifaceted services into one episode, bundled payments mask the impact that an individual procedure or service has upon the outcome of an episode. As Lamaze continues to gather data that demonstrates that evidence-based curriculum improves childbirth outcomes, it is critical that bundled models track individual impact.

3) Define Maternal and Childbirth Outcomes and Measures: Quality measures and outcomes are the building blocks to establishing and implementing best practices into the healthcare delivery system. As more provider, payer, and policy initiatives focus on reducing cesarean section and early elective delivery rates, prenatal and maternal outcomes and measures continue to become more relevant. Lamaze recommended that as the CEP Work Group eventually considers maternal and prenatal care outcomes and measures, it includes education and uses Lamaze's above definition of childbirth education.

In August 2016, the CEP Work Group released the final version of its proposed model and recently followed up with an accompanying fact sheet. The final white paper continues to include prenatal education and focuses on strengthening the voice that women and their partners have in the labor and birth process:

Care improvements must occur across the continuum of prenatal, labor and birth, and postpartum care in order to support a more patient-centered approach to care. Episode payment can address the need for appropriate, high-quality, prenatal and postpartum care.... providing education to the woman on what to expect during and after birth; and supporting her in making decisions about her preferences for interventions, settings, and provider types can all lead to a more engaged and healthier mother.

Lamaze is pleased to see childbirth education develop a more prominent presence within the prenatal and maternal care discussion and will continue to look for opportunities to advocate for evidence-based childbirth education. In doing so, Lamaze will to work to ensure that initiatives that include childbirth education get it right the first time by setting the bar high-to Lamaze International's standard.

For more information, contact Molly Giammarco, Senior Manager of Government Relations.About Molly Giammarco

Molly Giammarco is Lamaze International's Senior Manager of Government Relations. She obtained her BA from Smith College in Massachusetts and her MA in Public Policy from the George Washington University in Washington, D.C. Before joining Lamaze, Molly worked in the U.S. Senate for five years, where she focused on health policy.

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