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 The efforts are in very early stages, with few details on their
impact outside of cost savings of a few million dollars so far. But
they illustrate yet another path companies are taking to bring down
U.S. medical costs by working with doctors and hospitals to set
health goals.
GE's maternity strategy is designed to steer its employees to
hospitals that are believed to provide better care and less likely
to recommend unnecessary and costly interventions, company officials
told Reuters.
U.S. employer spending on maternity care rose 50 percent in the last
decade, fueled by a jump in C-section rates despite years of efforts
to curb the practice, according to research firm Truven Health
Analytics. For a graphic, see: https://tmsnrt.rs/2P1MPRs
"Maternity is one of the main drivers of high cost claims," for
employers, said Ellen Kelsay, chief strategy officer at the National
Business Group on Health. Avoiding unnecessary C-sections and
minimizing complications "decreases turnover in the workforce
following the birth of a child," she said.
General Motors Co <GM.N> said it has included maternity goals,
including reducing C-sections, in a new contract with a Detroit-area
hospital. Dow Chemical demanded explanations from hospitals that
care for its employees when its C-section rate hit 44 percent
several years ago. Now part of the merged company DowDuPont Inc <DWDP.N>,
it is working on new payment agreements with doctors and
administrators.
"We went to them and said how do you explain this?" said Steve
Morgenstern, Dow Chemical's North American Health and Insurance Plan
Leader, who called the rate "unacceptable."
"BUNDLED" PAYMENTS TO CUT COSTS
GE launched its Maternity Care Select Program in Cincinnati, Ohio,
home to its aviation business, where nearly 300 babies are born to
employee families every year.
Local hospital system TriHealth agreed to a single "bundled" payment
rate to care for low and moderate-risk mothers from the start of
pregnancy until 90 days after the baby is born, rather than charge
for each visit and delivery separately. That typically removes the
financial upside for C-sections, which cost nearly 60 percent more,
on average, than a regular delivery.
Adam Malinoski, GE's manager of health services, said none of the
company's health insurers offered bundled payments on maternity care
when it designed its program, so it decided to work directly with
providers.
GE pays the out-of-pocket costs for women who enroll, saving them up
to several thousand dollars. TriHealth and GE would not disclose the
bundled payment rates or how they compare with other hospital rates.
New deliveries under GE's program began in 2016, when only 78
pregnant women enrolled. In 2017, 136 women enrolled, TriHealth told
Reuters. C-section rates for first-time, low-risk deliveries, which
represent a small group within the program, dropped to about 6
percent in 2017 from 24 percent in 2016. That comes in well below
the U.S. rate of 26 percent for low-risk births.
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TriHealth would not disclose the C-section rate for the total group.
GE expanded the program to hospitals in Wisconsin, South Carolina
and Massachusetts in 2017 and announced a fifth location in New York
in August, but says it is too early to provide data for other
locations.
GE executives said the program so far has saved the company nearly
$2 million because of lower negotiated fees for maternity care. It
represents a fraction of its spending on the 113,000 employees and
family members enrolled in the GE health insurance plan, but a step
in the right direction, they added.
"WE WERE SHOCKED"
The rise of C-sections has been fueled in part by fears about
malpractice litigation, as well as expecting mothers with health
issues or who are older, which raise the risk of complications.
Hospitals say that makes them reluctant to set maternity goals. The
Stanford Health Care medical system works directly with employers on
health targets, such as diabetes care, but has so far refused to set
specific goals on C-sections.
In such higher risk cases, "it's entirely appropriate and (there's)
no way to determine upfront" who will need a cesarean, said John
Jackson, who handles corporate health partnerships at Stanford
Health Care.
Suzanne Delbanco, executive director of the nonprofit Catalyst for
Payment Reform, has worked with large employers seeking to reduce
C-section rates. But some companies "are still leery about wading in
too much," she said. "They don't want to alienate people, they don't
want to be accused of being Big Brother."
GM is taking its own shot at lowering costs and improving care with
a new health program, announced in August, that was created directly
with Henry Ford Health System in Michigan . Three of the program's
19 health metrics involve maternity care such as lowering C-section
rates, the company told Reuters.
The automaker's total C-section rates vary widely, from about 40
percent in the Dallas/Fort Worth area to 30 percent or lower in
Detroit.
"We were shocked," said Sheila Savageau, U.S. health care leader for
GM. "We have to change the system."
(Reporting by Jilian Mincer; Editing by Michele Gershberg and Edward
Tobin)
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