HUSKY maternal health bundle questions 2.0
Based on DSS’s MAPOC presentation Friday on plans for maternity bundled payments, the CT Health Policy Project submitted some questions about the plan. The commendable goals of the plan are to improve health outcomes, equity, quality, and access to care while controlling costs through care management and greater efficiency. DSS plans to pay obstetrics practices a case rate for each pregnancy, based on their historic costs providing care. The rate would be based on each practice’s historic spending and would be risk-adjusted to adjust for higher need patients. Practices that are able to save money on the total cost of care for their patients, will share in the savings. If costs are higher than the case rate, practices will not be penalized.
Building on previous questions and answers and public comment, the CT Health Policy Project raised new questions and concerns based on DSS’s subsequent planning.
The questions center on:
- Unintended consequences that are not being addressed in the planning
- The lack of planning to monitor for denying necessary care and cherry-picking more lucrative patients
- Concerns that quality and access are still to-be-determined and questions about the incentives for those goals compared to savings
- The impact on large health systems closing birthing centers
- Patient-centered quality metrics
- Fair access to doula services, that does not make disparities worse, and how to ensure the state doesn’t pay twice as happened in PCMH Plus, a similar HUSKY payment model that has failed to improve care or save money