More than one in three Connecticut births are covered by the HUSKY program, including some pregnancies at risk for poor birth outcomes. DSS has an ambitious plan to change the way providers are paid for those births. The goals are to improve equity, lower C-section rates, poor maternal outcomes, lower opioid-related pregnancy conditions, and reduce the rate of newborns needing the intensive care unit (NICU). The plan is to move from paying for each service separately to paying a set “bundle” price mean to cover all pregnancy-related care including hospital costs. Bundled payments will be risk adjusted to ensure more resources for more complicated pregnancies. Risk adjustment may potentially include social factors as well as medical risks. DSS has created a website with updates on their plan.
Advocates have concerns about moving back to a set-fee payment model that places financial risk on providers. Concerns include monitoring for inappropriate underservice (mothers and babies not getting the care they need), cherrypicking (providers choosing to serve more lucrative patients they can profit from), and the financial health of providers taking on significant financial risk and impacts on access to care.
Advocates sent a list of questions to DSS on the plan. The questions and answers are posted here.