More questions and answers on DSS’s plan for HUSKY maternity bundles
Read the new questions and answers
DSS is planning to move Medicaid payments for maternity services from the current fee-for-service arrangement to a per-person bundled payment. They will also expand services to include doula and lactation supports. However, advocates have asked questions and raised concerns about unintended consequences when providers make more money by reducing the costs of their patients’ care. While this could result in improved health outcomes, it can also result in denials of necessary care and avoiding less lucrative or difficult patients. This change comes as maternity care access is shrinking across Connecticut.
At the October MAPOC meeting, DSS provided updated details on their maternity bundle planning. Members had lots of questions about the new information at the meeting but were encouraged to submit more in writing as well. The CT Health Policy Project recently received answers to our questions and concerns.
In response to broad input from many sources, DSS identified plans to get timely, actionable information to providers so they can improve care quality and address gaps in care. DSS will also monitor, and adjust as necessary, the impact of the bundles on access to birthing centers and closures.
However, important protections inherent in the payment model against cherry-picking more lucrative patients and denying necessary care are vague and insufficient to protect patients. Low performers can still access their savings (which may have been generated by cherry-picking and/or underservice) by just drafting a plan to improve. And providers who invest in quality and perform well, but do not achieve savings in that year, will not be rewarded. This is inconsistent with the stated goals of improving quality and reducing disparities in care. Critical patient satisfaction monitoring is to-be-determined. Protections to ensure fair, equitable access to limited doula services are weak and measures to ensure that practices don’t benefit by getting credit for savings generated by better health outcomes from provision of doula services provided outside the practice.