OB Bundles are Coming to a Market Near You, Are You Ready?

This article is provided by Dorsata, ACOG’s partner in developing the ACOG Prenatal Record by Dorsata, a fully integrated EHR application. The ACOG Prenatal Record by Dorsata is an overlay for your EHR that was co-developed by ACOG and Dorsata and is in use today, by practices actively participating in Episode-of-Care contracts. If you’re interested to learn more about these contracts and how the ACOG Prenatal Record by Dorsata can help you succeed in them, sign up here.

As value-based care models continue to sweep across the country, health plans are rapidly rethinking their strategy when it comes to maternity. While obstetrical care has largely been paid for under a global payment, new Episode of Care payment models for maternity are quickly gaining steam and expanding incentives (and requirements) for ob-gyns. These models, while they may seem burdensome and complicated at first, present attractive opportunities to ob-gyns that implement sound processes that help them deliver (pun-intended...) high quality and high value care to their patients. Success under these types of contracts requires a granular understanding of your practice and diligent, day-to-day execution. Groups who do this successfully will be able to opt-in to take risk, further growing their reward for providing value-based care.

Obstetrical care has traditionally been referred to as “the original bundle”. All services for antepartum, delivery, and postpartum care for an uncomplicated pregnancy are paid for under a single CPT billing code. While this has an appearance of being a “bundle”, this payment model only capitates approximately 15% of the total cost of the average birth. Outside of prenatal and post-partum office visits and the professional fee for delivery, all other costs are billed separately. 

These costs fall into three primary categories:

1. Lab testing
2. Imaging
3. Facility charges

New Episode of Care contracts rewards providers that deliver good value across the entire episode, not just the office visit portion. Cigna, Anthem, and a variety of state Blues offer Episode of Care models for OB that go well beyond the traditional global payment. This presents significant opportunity for ob-gyns to earn more by increasing the value of the care provided, but there are some essential things to know before signing onto these contracts:

Understand your Contract Objectives and Incentives

Many of these contracts include incentives for things such as reducing primary cesarean rates, non-indicated inductions of labor, smoking cessation counseling,and increasing rates of various screenings such as depression screening, hepatitis B, and glucola.

Understand and Monitor your Performance

Seeing 30 to 40 patients per day makes managing these types of initiatives, particularly making sure that certain screenings are done at the proper points in time, incredibly challenging. While you might think that your current electronic health record can provide you with all of the data you need to operate on these contracts, it can be very difficult to even look at a single list of the current patients you are managing under a certain type of insurance. Luckily, tools like the ACOG Prenatal Record by Dorsata can provide you with a multitude of ways to slice and dice your data. Tools like this enable you to manage your active population and identify improvement areas.

Craft a Strategy to Execute

By understanding your data and performance going in, you can effectively forecast how you will perform. After that, it’s about continuously monitoring your performance and taking steps to adjust your process and workflow to achieve your desired metrics. Once you feel confident, you can increase the value you receive by taking downside risk. Find the right tools that can take on the burden of measuring and monitoring your performance so that you can focus on your patients.

Learn more about Dorsata

Available now for members who use athenahealth’s EHR, the ACOG Prenatal Record by Dorsata enhances the way prenatal care is managed across the care team. We are expanding our connectivity and will begin to roll out additional EHR integrations with Epic, Greenway, NextGen this year. Interested in viewing a demo? Visitthe Dorsata website or email us at [email protected].