There’s a big gap between our current maternity care system and the high-quality, high-value system envisioned by a multi-stakeholder Transforming Maternity Care Project Team. We’re glad to see many of the recommendations put forth in the Blueprint for Action garnering broader interest and gaining momentum. Here are four we expect to play a growing role in system transformation over the coming months and years.
Women- and Family-Centered Maternity Care Homes
Just about everyone agrees that the patient-centered medical home will transform primary care. But we’ve seen little attention to how best to provide this model of prevention-oriented, personalized, coordinated care to childbearing women and newborns. Although we’re just beginning to see implementation, the woman- and family-centered maternity care home concept seems to be gaining ground. North Carolina’s Pregnancy Medical Home program provides incentives to Medicaid providers to better coordinate health and social services for pregnant women and provide evidence-based care to reduce preterm births and cesareans. We’ve also seen interest in this concept in Minnesota, although legislative hurdles remain. We expect to see more innovation in this area, especially as the economic crisis and Medicaid expansion force payers to focus on cost containment and value.
Midwives, birth centers, and home birth
Just in the past month, an obstetric leader called for increased use of midwives to help curb the rising cesarean rate, Illinois cleared a regulatory hurdle paving the way for 10 freestanding birth centers to open across the state, and several major news sources reported on the rise in planned home births. Given the major cost advantages for out-of-hospital births, decades of evidence showing safety and benefits of midwifery care, and multiple forces aligning to produce critical workforce shortages, we expect midwives, birth centers, and home birth to gain the same interest among payers and policy makers that they’ve long had among consumers.
Shared decision making
Shared decision making is another broader health care trend that we expect to see find its due place in maternity care. Health care leaders are looking to shared decision making to make care more patient-centered, improve safety, rein in unwarranted practice variation, and reduce costs. While SDM found its roots in primary care and surgical specialties, our own collaboration with the Foundation for Informed Medical Decision Making represents the first major commitment to expanding the tools and concepts of SDM to maternity care. Look for a new maternity SDM web site and a suite of decision aids in the next year.
Facilities, providers, payers, and other stakeholders are joining forces to assess, track, and improve quality and safety. While quality collaboratives are not new, maturing information technology systems and new quality measures are enabling and accelerating data-driven improvement. Whether its hospital systems like Hospital Corporation of America, Geisinger, or Intermountain; state collaboratives like those in California, Ohio, Washington, and Oklahoma, or national collaboratives like the IHI Perinatal Improvement Community, we’re seeing major momentum from these entities in tackling safety problems and disseminating and replicating best practices.
What maternity care trends are you watching?