Bringing Accountable Care to Maternity Care: A Critical Look at Recent Research
In a recent article published in Health Affairs, the headline boasted that a Medicaid ACO program in Massachusetts had improved maternity care. However, upon closer examination, the study’s findings were lackluster at best. While there was a slight increase in pre- and post-natal visits for pregnant patients enrolled in ACOs, there were no significant improvements in maternal or fetal outcomes. The authors also found only a minor reduction in c-section rates, which fell far short of what is needed to align with global standards.
The study failed to address the complex needs of pregnant patients, particularly those with moderate to high-risk pregnancies who are typically managed by obstetricians or maternal fetal medicine specialists. The idea that maternity care can be adequately handled within already strained primary care systems is not only dismissive but also potentially harmful.
For true transformation in maternity care, we must focus on implementing accountable care strategies that are specifically tailored to the needs of pregnant women. This includes utilizing a team-based medical home model that incorporates a variety of specially-trained clinical roles such as OB/GYNs, CNMs, and doulas. Embracing bundled payments, pay-for-performance incentives, and other accountable care tools can help drive meaningful change in maternity care outcomes.
Moving forward, it is imperative that we shift our focus from process improvements to outcomes improvements in maternity care. By acknowledging the unique challenges and complexities of pregnancy care, we can pave the way for a more modern and effective approach to maternal health.
