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Pregnancy care: 2 value-based opportunities (and 2 red herrings)

    Childbirth is the leading cause of hospitalization in the United States. And in our analysis of the most costly sub-service lines in a national commercial claims data set, labor & delivery ranks thirteenth for highest costs overall, fifth for highest costs among women. When combining professional and facility claims costs, vaginal births cost approximately $11,000 and Cesareans cost approximately $17,000. And that’s delivery alone—prenatal and postpartum care are also part of the equation.

    Despite the high spending, maternal health outcomes are far worse in the U.S. than in other industrialized nations, with Black and Native American patients facing disproportionately poor outcomes.

    This makes pregnancy care a priority for providers, plans, and employers alike. There is opportunity to generate in-year savings due to pregnancy’s finite timeline and address one of the starkest health disparities. Below are two opportunities to improve quality and reduce costs in pregnancy care (and two red herrings that aren’t worth the effort).

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    The future of value-based care

    Medicare and Medicaid risk is progressing (slowly) – but commercial risk will determine whether the industry tips toward a new cost and quality standard.

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