Prenatal care in the United States is a bit of a crucible for issues related to rising health costs, telemedicine, and medical collaboration.
Maternity and prenatal care are at the nexus of high-pressure healthcare, patients with often-routine but occasionally hyper-sophisticated care, and the high cost of care. For instance, OB-Gyn providers consistently have the highest rates of malpractice law suits in all of medicine.
As the leading edge of healthcare, prenatal care is an interesting lens through which to see common dynamics in the rest of medicine. So two new articles are relevant to all of us, even though they're focused on prenatal medicine.
First, UnitedHealthcare is launching bundled payments for maternity care. It will roll out the program to 20 provider groups by the end of the year. Under this program, providers will be paid a lump sum for prenatal, delivery and postpartum care.
While a small percentage of all maternity care in this country, I believe that the impact of this program will be outsized. As a huge cost center within healthcare, insurers have a keen interest in shaving prenatal costs in any way they can. And a bundled payments system is, potentially, a way to do that. In a hypothetical kind of way, this program makes a lot of sense for everyone involved. In practice, the onus of doing the care coordination and medical collaboration that is demanded by a bundled payments system is huge. It requires that providers manage the diversity of providers across the continuum of care, and across the length and breadth of prenatal scenarios -- from the most simple to the most complex.
I do think that eventually, this kind of integrated payment system is what we need for healthcare. But in the short and medium term, I think it's unwise to just pay in a bundle without giving providers the appropriate tools to make sure the requisite care coordination happens. It's a "sink or swim" model, without giving providers the tools they need to swim.
Related to this is a study done to see whether a prenatal app could complement in-person visits effectively. Prenatal care has a notoriously intensive visit schedule -- which can be burdensome on both the patient and on the providers. But, as Fierce Healthcare reports, “providers say visits are hard to cut back on due to decreased patient satisfaction, the need for weight and blood pressure monitoring as well as the importance of providing educational information around pregnancy health.” So a new study looked at whether an app providing weight and blood pressure monitoring, as well as timed education for expectant moms, could be as effective as in-person visits for lower risk patients. The results? Patients were able to use the app to decrease their number of prenatal visits by about 20% without a decrease in patient or provider satisfaction. That said, it was a very small study size of less than 100 patients and perhaps more investigation is needed.
On one hand, I was excited to see the study of the use of the prenatal app -- as it's an example of actually providing a tool, rather than just changing how payments happen. On the other hand, I wonder whether it's the best tool we can come up with. I'd like to see more communication and coordination, and a more holistic approach -- rather than simply remote monitoring and one-size-fits-all education.
I applaud any effort to improve healthcare and to use technology to evolve how we communicate and care for our patients. That said, I also think that it's important that we continue finding ways to care for our patients better -- not just less or more cheaply.