The Potential of Value-Based Care in Obstetrics
Value-based care initiatives have made progress in primary care, but remain rare in specialties such as obstetrics. In a recent podcast discussion with NCQA, Tiffany Inglis, M.D., Carelon Health’s national medical director for women's and children's health, spoke about the Elevance Health Obstetrics Practice Consultants program, which has won an NCQA Health Innovation Award and has introduced many OB/GYNs to value-based care concepts.
An OB/GYN by training, Inglis practiced for about 15 years before joining Carelon, which describes itself as a payer-agnostic subsidiary of Elevance Health that brings together the company’s healthcare services brands and 40,000 employees to help solve complex challenges across the health ecosystem.
She noted that Elevance Health is involved in about 12% of the nation's births. A little less than 50% are Medicaid deliveries, and a little more than 50% involve commercial insurance. That scale allows it to address some of the health equity issues in the maternal care space and help more providers offer evidence-based care.
She described the OB practice consultants as a group of clinicians — nurses, for the most part — who work together to support providers. “The person on our side has very much a clear line of sight into all of the member programs and options that they have available to them. They are linked to the plan, but they are the point of contact for the OB/GYN or midwife, and the point of contact for their staff to be able to say they need something,” Inglis said. “We align a person to these providers to be the touch point, share data on outcomes — C sections, preterm birth rates, who still needs to get a postpartum visit. OB practice consultants are the practitioner’s coach or go-to inside the health plan.”
There is a focus on value-based care, she added. The providers don't have to be in a value-based care contract to get the support from the practice consultants, Inglis explained, “but when they are in that relationship, they get deeper data, deeper knowledge that can help close care gaps, make sure patients get care they need, make sure patients get services available that maybe that the doc doesn't know they have. We're working within our value-based care solutions across the lines of business, and making sure that both value-based care-aligned physicians and non-aligned are getting the support from this team.”
She added that her team also can recruit providers to participate in value-based care arrangements and answer any questions they have.
The Obstetrics Practice Consultant Program was launched in 2015 with one person for a couple of years. Now, it has almost 40 staffers. “What we started with when we were a smaller team was focused around Medicaid,” Inglis said. “Until 2022, that was our only focus. We expanded the program to start supporting our commercial deliveries. We are working with the same docs, because most OBGYNs are delivering babies that are Medicaid members and commercial members.”
Inglis said that when they created the offering, they really didn't know if it would work. “It's different than anything else we ever offered,” she said. “Our providers are terribly happy with the program, and the program has grown, not only because people like it, but because this has driven huge changes, a significant improvement in low-birth weight babies. In our recent evaluation, 20% fewer low-birth weight babies were born, and a 12% reduction in preterm birth. Those are big numbers and a significant improvement in prenatal visit compliance, postpartum visit compliance. The thing that's been most eye-opening is we can really impact outcomes. This has been our biggest lever.”
She noted that traditionally value-based care has been primary care-focused, and for OB/GYN it was a newer phenomenon. “To some it's still fairly a new concept. There is an element of distrust in the medical community between plans and providers, hospitals and plans, providers and hospitals. Some of it is that they think it's another way to limit their payment.” But Inglis added that the biggest issues are often administrative, and making sure things are being documented. “Once you can make them comfortable with that, it's going to amplify the fact that you're providing evidence-based care….We all want better care and better outcomes. We just have to figure out how to get there together. We want to improve care together, and we believe value-based care gets us there, so let's reinforce evidence-based care. Let's get these improved outcomes. Let's increase patients access to care and make sure they're getting in for visits.”
