23 May Task Force Comments on LAN Maternity Care White Paper

The Health Care Transformation Task Force commends the work of the Health Care Payment Learning and Action Network’s Clinical Episode Payment Work Group on its draft White Paper on Maternity Care Framework and provides recommended refinements.

Our recommended refinements to the Maternity Care Model design include

1. Episode Timing. The Task Force advocates adjustment of the episode definition and price based on differing numbers of prenatal visits.
2. Patient Population and Transparency in Episode Creation. We continue to advocate for full transparency in all matters related to bundled payment programs, including the specific methodology for setting target prices for each hospital or participant.
3. Services. We support the White Paper’s inclusion of services that are not commonly covered but beneficial to maternity care including care provided by doulas, care navigators, group prenatal visits, and breastfeeding support.
4. Patient Engagement. The Task Force supports notifying mothers of their involvement in a bundled model via a beneficiary notification, but we do not recommend requiring an active agreement to participate in the model.
5. The Important of an Accountable Entity. We urge the LAN to be inclusive, rather than exclusive, on the accountable entity question to encourage innovation and foster market-based arrangements dedicated to bundled payments.
6. Payment Flow. Initial determination of whether a mother is considered ‘low risk’ can be made at the first prenatal visit. However, this status can change during the course of pregnancy. For this reason, a retrospective payment model may be a better choice than a prospective payment model for maternity care.
7. Type and Level of Risk.
8. Patient-Focused Quality Metrics. We support the use of patient-reported outcome and functional status measures. However, we recommend that providers only be subject to performance in quality metrics that have been validated by sufficient data and accepted by institutions such as the National Quality Forum or the Perinatal Core Measures.

Read the letter for more information on the recommended refinements to the LAN’s Maternity Care Model design.

Read the letter here

Letter submitted on May 23, 2016