Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.



Pregnancy care: 2 value-based opportunities (and 2 red herrings)

Childbirth is the leading cause of hospitalization in the United States. And in our analysis of the most costly sub-service lines in a national commercial claims data set, labor & delivery ranks thirteenth for highest costs overall, fifth for highest costs among women. When combining professional and facility claims costs, vaginal births cost approximately $11,000 and Cesareans cost approximately $17,000. And that’s delivery alone—prenatal and postpartum care are also part of the equation.

Despite the high spending, maternal health outcomes are far worse in the U.S. than in other industrialized nations, with Black and Native American patients facing disproportionately poor outcomes.

This makes pregnancy care a priority for providers, plans, and employers alike. There is opportunity to generate in-year savings due to pregnancy’s finite timeline and address one of the starkest health disparities. Below are two opportunities to improve quality and reduce costs in pregnancy care (and two red herrings that aren’t worth the effort).

Not a member? Get a complimentary preview of this research.

The future of value-based care

Medicare and Medicaid risk is progressing (slowly) – but commercial risk will determine whether the industry tips toward a new cost and quality standard.

Opportunities: These tactics span the pregnancy care pathway and require initial up-front investments.
  • Embrace comprehensive risk screening and support.
  • Explore new and appropriate sites of care.

Red herrings: These areas may seem appealing at first but are more trouble than they’re worth.
  • Don’t lose trust by over-focusing on cesarean rates.
  • Stay aware of the limited evidence behind genetic screenings.

Parting thoughts

Since childbirth is the number one reason Americans are hospitalized, it’s a great place to focus value-based care efforts. By focusing on the full pathway before, during, and after delivery, organizations can lower costs and improve outcomes. And it’s one of the few opportunities for short-term cost savings in the commercial patient population.

More commercial claims analysis:

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.