The case for value-based care in women’s health: A win-win in improving maternal care

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Over the past several years, providers and technology-focused physician enablement organizations across the country have been working together to initiate the transition from traditional fee-for-service models to value-based care (VBC) arrangements. They have been adopting analytics tools and service solutions to help improve health outcomes, provide more cost-effective care and close gaps in care, all of which drive efficiency for doctors, their patients and payers.

Keith Berkle, MD, MBA
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Primary care specialties have benefited significantly in VBC, improving clinical outcomes dramatically and receiving healthy financial rewards for thorough execution. However, despite the immense benefits VBC has demonstrated in other specialties, the transition from fee-for-service has largely been nonexistent in women’s health to this point. Obstetrician-gynecologist (OB-GYN) practices face a lack of standardized women’s health measures across the health care system and in Medicare. The absence of uniform measures has created varying levels of reimbursement and costs, ultimately presenting challenges to implementing VBC in a comprehensive way. Commercial payers likewise have been slow to develop thoughtful VBC contracts specific to women’s health. It is an area of medicine mired in partisan semantics designed by policy makers on both sides to ensure forward progress is all but impossible.

Women’s health and VBC

Women’s health is organically rooted in the principles of VBC — results-driven care that is critical for the health and well-being of women and the mother-child dyad. As outside factors influence women’s health policy making more and more, empowering OB-GYN practices across the country in their transition to VBC is more important than ever to ensure that expectant mothers are receiving the best care possible and that women experiencing gynecologic conditions have access to the most up-to-date care, especially for our most vulnerable patients, for whom care options are limited.

By accessing a robust catalog of women’s health technology solutions, OB-GYNs not only are better equipped to successfully care for patients in VBC models but can also utilize innovative solutions to navigate the unique, complex needs of women’s health care more effectively. Solutions like remote monitoring and telehealth services connect providers and patients at critical points when an office visit may not be necessary or isn’t possible. Pregnancy tracking and education apps can keep patients informed on what to expect and allow providers to share gestational age-specific information in real time. Virtual fertility, lactation and nutrition resources allow access to more specialized types of care that have historically been less accessible to minority groups and Medicaid patients. Electronic health records (EHRs) designed for success in VBC also tend to have deeply integrated best practice guidance to help providers manage the ever-increasing body of knowledge in women’s health.

Closing the gap on maternal health care for at-risk populations

Over the last 25 years, the U.S. maternal mortality rate has been steadily rising, with an increase of 144% from 1999 to 2021. Continued disparities in access to quality maternal health care have contributed to this increase. As care gaps continue to put expectant mothers at risk of life-threatening complications, OB-GYNs and care centers must implement quality improvement plans and initiatives that close those gaps, particularly for our nation’s most vulnerable communities. VBC in prenatal care holds the promise of equipping OB-GYNs with technology solutions that help them provide more timely, effective care at all points of a pregnancy and also of empowering patients with the knowledge they need to feel confident in the care they’re receiving.

Improving care coordination and driving better outcomes in VBC by integrating into a practice an EHR that leverages not only innovative technology but provider-oriented (and even provider-developed and -led!) workflows and decision support has dramatically increased the quality of care in primary care specialties. These strategies can similarly help OB-GYNs improve how they monitor a patient’s health throughout pregnancy and efficiently provide care at key moments. By effectively collecting patient information early in pregnancy and monitoring through a robust EHR designed and augmented with them and their patient population in mind, OB-GYNs can more easily identify patient risks that could complicate pregnancy and receive alerts that prompt planning and intervention at key points of care to address their patients’ needs and satisfy VBC standards comprehensively.

Further, patient-facing platforms through smartphone apps inform expectant mothers of health concerns or care needs throughout their pregnancy. By seamlessly integrating with EHRs, these platforms can help patients directly access educational resources and safety alerts, empowering them to play an integral role in their health and their baby’s, while improving their health literacy to better understand and participate in the care they need.

Ensuring the benefits of value-based care for expectant mothers everywhere

A key feature driving the success of VBC programs in other specialties is a relentless focus on access. Ensuring all expectant mothers across the country can access an OB-GYN regardless of where they live is a crucial next step. The most significant gaps in maternal care often occur in rural communities, where patients may live far from their OB-GYN and lack access to private or public transportation.

Without sufficient means to reach their doctor, expectant mothers may not only feel higher levels of burden or stress in receiving the care they need but may also be at greater risk of socioeconomic challenges that create pregnancy-related health emergencies.

While most expectant mothers in rural communities would prefer to see their OB-GYN in person, virtual visit platforms can serve as a complementary option that allows doctors to check in with their patients remotely and improve access. Through virtual platforms, rural maternal patients can feel confident they have a better understanding of their health needs throughout their pregnancy and make in-person meetings more meaningful and insightful based on virtual interactions with their doctors.

Additionally, telehealth services can help expectant mothers reach certified nurse practitioners, physician assistants or other care support staff who can triage immediate questions that don’t necessarily require a doctor’s input or can help a patient schedule a follow-up appointment with a doctor if needed. A natural extension of virtual care options from OB-GYNs, these services not only expand access to more immediate maternal care for patients regardless of where they live but can also reduce unnecessary emergency room visits and overall health care costs.

Conclusion: A better way forward for maternal health

VBC has the potential to play a critical role in improving the state of women’s health in America by supporting OB-GYNs in enhancing their focus on patient outcomes and rewarding them for high-quality care. There is a significant opportunity to improve the care not only of the maternal-fetal dyad but of women experiencing other gynecologic conditions like endometriosis, fibroids, menopausal syndromes, pelvic pain and more. The technology developed at scale by OB-GYN and other aggregators is designed with these benefits in mind.

In maternal health, success in VBC involves participation from the OB-GYN and the patient and requires thoughtful, forward-thinking plan development from payers. By equipping providers and patients with technology solutions to help them better understand the care journey, patients and doctors can forge stronger bonds that boost engagement and optimize health outcomes for expectant mothers and their children, no matter the circumstances.

Keith Berkle, MD, MBA, is the chair of the Privia Medical Group — Mid-Atlantic Board of Governors and president of Virginia Women’s Center, a Privia Women’s Health practice. Outside the office, he is a member of the Richmond Academy of Medicine’s Access Now program and has engaged in surgical missions to Guatemala to provide free gynecologic care to underserved populations.