This weekend I was in Washington D.C., where the scent of health care reform is as pleasant as the cherry blossoms, for a meeting of the minds on the subject of a particular brand of care: That for pregnancy and childbirth.
Childbirth is the number one reason why someone is admitted to the hospital (more than 4 million babies are born in the US every year) and the biggest contributor to the cost of health care, comprising 17 percent of the country’s GDP. About 47 million people are uninsured in this country and many more are under insured.
So the topic is huge, no pun intended.
About 150 thought leaders (myself included, as the author of Birth: The Surprising History of How We Are Born) from around the country attended Transforming Maternity Care: A High Value Proposition, a confab to make evidence-based care a national conversation.
Long overdue, in my book, given that the national c-section rate is at an all-time high of nearly 33 percent, and other procedures and interventions endure despite research showing they should be a last resort, not the first. But evidence-based care isn’t always enough to change the behavior of consumers, doctors or public policy makers. There needs to be a carrot and stick.
Some of the recommendations from today, which have broader applications throughout the health care universe:
--In the absence of a consumer groundswell, we need to change the system, specifically, we need a new payment system. Right now we pay for procedures. An overhauled system would reward good evidence-based practices (and discourages those that are not). For example, steer payments toward things such as providing a safe environment for VBACs, offering smoking cessation programs and diabetes control; don’t reward the overuse of technology, don’t reimburse elective inductions at 39 weeks. What if insurers paid more for first-trimester visits than third-trimester visits? Paid more for vaginal births than c-sections? Paid more for midwives than physicians?
--Develop national measures for birth outcomes, something necessary to accomplish the above.
--Reduce the threat of malpractice by using evidence-based care, but also by setting up a financial system for disastrous outcomes that are no one’s fault (Sweden and New Zealand are models for this). We should also incentivize such things as having obstetrical teams practicing emergency situations to earn a reduction in malpractice insurance premiums, something already being done in Boston’s Harvard system. Establish “apology” laws so providers can express remorse without admitting malpractice.
--Within health plans, foster transparency and access to caregiver choice (ie. midwife, doula, doctor, etc.).
--Find legislative options to fix the disjointed system of health information technology (only 17 percent of hospitals have such systems, but NIH is spending stimulus money to try to fix this) while maintaining appropriate privacy about reproductive issues. In the UK, women carry their own medical records for maternity care – “no, they don’t lose it,” one panelist said, adding that such a policy is a symbolic shift of authority. HIT won’t work if we just digitize patient information; we need to embed performance measurements, and code information better to enable data collection.
--And, last but not least, provide more effective communication to consumers through a large- scale public awareness campaign about evidence-based care. Coincidentally, new information has just been released regarding the idea of seasonal birth defects.
For more on the day, go to my personal blog related to childbirth, at www.tinacassidy.blogspot.com. Or to post comments about the symposium, go to www.childbirthconnection.org/symposiumcomments.
---Tina Cassidy is a Vice President at Solomon McCown & Company. She can be reached by email at tcassidy@solomonmccown.com
