Blue Distinction Centers for Maternity Care hospitals lowered C-section rates to 23.7% for first-time mothers compared to 34.9% for hospitals that are not in the network, and saved about $4,000 per delivery.
The Blue Cross Blue Shield Association says its hospital maternity care program has reduced cesarean sections for first-time mothers by 32% when compared with hospitals not in the program.
According to BCBSA, Blue Distinction Centers for Maternity Care:
- Lowered C-section rates to 23.7% for first-time mothers compared to 34.9% for hospitals that are not in the network;
- Beat the Department of Health & Human Service's Healthy People 2020 goal to reduce C-section rates for first-time, low-risk mothers to 23.9% by 2020;
- Saved money because the average cost difference between vaginal and C-section deliveries is more than $4,000 ($13,325 vs. $17,482, respectively);
- Have 70% fewer early (37-39 weeks) elective deliveries and 53% fewer episiotomies, than non-network hospitals.
Nearly four million babies are born in this country each year, making childbirth the most common reason for hospitalization.
The maternity program started in 2016, and is now in more than 1,080 hospitals across the nation. To qualify a hospital has to achieve a C-section rate of 27% or lower, and other outcomes metrics.
Kari Hedges, senior vice president, commercial markets & enterprise data solutions for BCBSA, says the three key metrics for the program are early elective deliveries, episiotomies rates, and C-section rates.
"We put a threshold where the providers have to perform better in each of these categories," she said.
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Hedges credited the success of the program on the member hospitals' efforts to proactively communicate with expectant mothers "around healthy maternity care and what they need to do to stay healthy."
Those conversations also "discourage early elective deliveries, and spell out the potential complications that come with scheduling and planning C-sections versus having them being used for their intended purpose," Hedges said.
ACOG Approved
The maternity program's criteria relies on safety bundled developed by several key stakeholders, including the American College of Obstetricians and Gynecologists. The bundles tap best practices to prevent or respond to common pregnancy-related conditions, such as hemorrhage and hypertension.
Barbara Levy, MD, ACOG's vice president of health policy, said her organization is "excited" about providing a link to its patient safety bundle to reduce maternal morbidity and mortality.
"Encourage hospitals to engage in behaviors that are safer for moms is what we are all about," she said. "If the hospitals invest in great nursing care and lots of support, then we know the outcomes will be better and more likely it will be a vaginal delivery."
Litigation Fears and C-Sections
Levy was asked how C-Sections became so commonplace in hospitals for non-complicated pregnancies.
"There are several issues there," Levy replied. "Women are older, they have more underlying medical conditions over the past 20 years, and quite frankly the liability risks for obstetricians is really scary."
"A doctor is never sued for doing a C-section too soon, but in retrospect, if there is an outcome that isn't ideal, those things lead to litigation," she says.
"Some expert will say 'you could have, should have, would have done a C-section and none of this would have happened.' The reality is that in obstetrics almost every doctor will be sued. It makes you think twice about what you're doing. That's not great, but it is reality. So, what we've seen in the last 25 years is a reduction in operative vaginal delivery."
"Almost directly related to medical liability, those operative delivery cases are disappearing and the skills to do them are disappearing, and that results in more primary C-sections for a first pregnancies, and then that leads to more repeat C-sections," Levy says.
John Commins is the news editor for HealthLeaders.