by Jill Clendening
Hearing that she could deliver her second child with no out-of-pocket expense convinced Vanderbilt University Medical Center employee Amy New to enroll in the new MyMaternityHealth Bundle offered by Vanderbilt Health, and she quickly learned the program’s advantages didn’t stop there.
New, director of programs for VUMC’s Office of Government and Community Affairs, contacted VUMC Patient Navigator Bri Yip about the MyMaternityHealth Bundle, and by call’s end, she was enrolled, and her upcoming prenatal visits were scheduled at a location most convenient for her, Vanderbilt Nurse-Midwives & Primary Care for Women at Melrose.
“The option of having telemedicine visits from home was super appealing because we won’t have to go into a brick-and-mortar location for some appointments,” New said. “I’m also excited about getting a fetal heartbeat monitor and a blood pressure monitor to use for my telemedicine visits.”
As of Jan. 1, VUMC began offering the MyMaternityHealth Bundle to Metro-Nashville Public Schools (MNPS) Cigna health plan beneficiaries and VUMC employees covered under Aetna Plus or Aetna Select medical plans. By the end of January, more than 50 expectant mothers had enrolled, with 20 of those being expectant mothers from MNPS. In 2019, 30 MNPS mothers delivered at VUMC, indicating the program is off to a great start, said Ronald Alvarez, MD, chair of VUMC’s Department of Obstetrics and Gynecology.
“For us the impetus is to not only grow volume, but also to really re-engineer the maternity and delivery experience for patients,” Alvarez said. “We can no longer offer a one-size-fits-all model of care for our pregnant patients. We have to think more about what the needs are of our patients and build a health care system that meets these needs in innovative ways. If we can do that well within this model, we have the opportunity to scale it up to offer to more of our patients who would ordinarily get fee-for-service care.”
“This is a wonderful benefit for MNPS’s educators and their babies,” said Adrienne Battle, EdD, interim director of MNPS. “As we work to retain and recruit the best talent for every school and every classroom, this program will go a long way by providing educators and their newborns first-rate care while reducing the out-of-pocket costs that can add up during and after a pregnancy.”
Average out-of-pocket costs for maternity care among women with employer-based insurance jumped to $4,569 in 2015 from $3,069 in 2008, largely due to higher deductibles, according to a recent study in Health Affairs. While the cost of having a baby remained stable in the U.S. from 2008 to 2015, patients paid 20% of total maternity costs in 2015 compared to about 12% in 2008.
While the MyMaternityHealth Bundle has no out-of-pocket cost during the program’s initial year, beginning in 2021, a copayment, which has not yet been set, will be required.
The MyMaternityHealth Bundle program coordinates and “bundles” all services an expectant mother and baby need from the initial prenatal care visit until 12 weeks after delivery.
Eight Women’s Health practices located in Davidson, Williamson, Wilson and Rutherford counties participate in the program, all of which deliver at VUMC. There are future plans to expand to include Vanderbilt Wilson County Hospital (VWCH). Baby wellness visits following delivery and retail pharmacy expenses are excluded, said VUMC Episodes of Care Director Brittany Cunningham, MSN, RN.
“About half of the prenatal visits can be telehealth visits, at the discretion of the primary provider,” Cunningham said. “Everything you normally get through your maternity care is included — visits with your primary provider, lab work, ultrasounds — and the patient navigator checks in periodically to make sure the patient is getting everything they need. Then, when they deliver, no matter if they have a C-section or a normal delivery, both are included.”
For decades, the bundled payment concept has been part of the health care reform debate in the United States as a strategy to improve health care quality and reduce health care costs. The Centers for Medicare & Medicaid Services (CMS) and commercial insurers continue to introduce new bundled payment models, and health care providers are increasingly developing bundled care options.
The bundled payment concept pays providers (such as hospitals and physicians) a single fee to deliver all the services related to a patient’s course of treatment for a specific illness, condition or medical event. This differs from the traditional fee-for-service model in which providers are paid separately for each service. Bundled payments reward the delivery of high-quality, efficient care and allow providers to redesign the patient care experience.
“We believe VUMC can deliver a better patient experience, and our bundled payment program will make that possible,” said C.J. Stimson, MD, JD, medical director of the VUMC Office of Episodes of Care and assistant professor of Urology. “Bundled payments throw out the traditional insurance payment rules that get in the way of patient-centered care. Without these restrictions, VUMC providers are free to redesign the clinical and service experience in a way that is 100% focused on maximizing patient outcomes and satisfaction.
“This is exactly what our maternity providers and staff have done with the MyMaternityHealth Bundle program. The world-renowned clinical care VUMC has always provided to pregnant women in our community, now with the freedom to deliver an exceptional level of service and an unparalleled patient experience.”
New and her husband, Jake, have begun prenatal appointments with Lori Cabbage, MSN, CNM, and they’re looking forward to listening to their baby’s heartbeat at home with their 8-year-old daughter Lily Kate.
Expectant mothers must be enrolled in the MyMaternityBundle program before their first clinical appointment in order to participate. There are plans to expand the program to other employers/insurers in the future.
To learn about MyMaternityBundle and to see a full list of covered services visit www.MyMaternityHealth.com. To connect with a patient navigator, fill out the online registration form.
