How One Payer Expanded the Boundaries of Maternal Healthcare Benefits

October 17, 2022 - Investing in maternal healthcare may seem like a natural decision on an individual level, given the influence that positive, healthy parenting can have on a person’s life and the many healthcare needs that parents face.

In reality, however, maternal healthcare in the American healthcare system is fragmented, both in its delivery and coverage. Moreover, it is rife with care disparities and inequity.

Inequity was one of the factors that Aji Abraham, senior vice president of Health Plan Business Innovation and Market Solutions at Blue Cross Blue Shield of Michigan (BCBSM), took into account as he and his team sought to improve maternal outcomes and coverage.

“There were a ton of reasons [to integrate family-building and maternal care]. The primary driver, though, is to make sure that everybody—regardless of who they are or where they are, what part of our society they're in—that they all get an opportunity to live their best lives,” Abraham explained.

“What has enhanced the focus on it is the crisis that we're seeing across the country in maternal health and maternal outcomes, especially as it relates to African American women and minority populations.”

The dearth of health equity in maternal care is evident in racial, income-based, and geographic disparities.

When compared to other developed nations, the US maternal mortality rate was more than triple the runner-up (France), according to a Commonwealth Fund report. The US had an overall mortality rate of 23.8 deaths per 100,000 live births, compared to 7.6 deaths per 100,000 live births in France. Among Black American women, the mortality rate was even more aggressive: 55.3 deaths per 100,000 live births.

“There's not really a good explanation for it,” Abraham said. “We need to help fix it.”

Another major driver—that also posed a challenge for employers and payers—was the complexity of healthcare in general and family or maternity healthcare specifically.

“Healthcare in general is very complex. It's not easy to decipher even if you're part of this system. So we need to do a better job of making it simple, easier for people to access, more affordable in many cases,” Abraham continued.

Given these factors, Abraham and his team at BCBSM decided to go beyond traditional maternal healthcare benefits, such as prenatal and postpartum care coverage. They teamed up with a virtual care provider for women and family health, Maven, to offer a suite of solutions that integrated family care and maternal healthcare.

Constructing a comprehensive set of maternal benefits

The payer worked with Maven to integrate BCBSM’s existing maternal benefits, programs, resources and maternal healthcare network into Maven’s platform.

By collaborating with Maven, BCBSM and Blue Care Network offered virtual care and care management solutions for family planning, family healthcare, and maternal healthcare. Members can connect with a care manager at any time. Also, they can reach one of 30 specialists through virtual care within 30 minutes.

There are three programs that the partners offer which span a variety of maternal and family needs.

Members have access to support for their journey through the family-building program. This program addresses fertility, adoption, surrogacy, and other paths to family-building.

The maternity program lasts for a year and includes prenatal and postpartum resources. It also encompasses NICU support and care management for high-risk pregnancies. There is an additional, free partner track for spouses who are covered.

The third program is the parenting and pediatrics program. It serves children from ages one to ten. Additionally, parents can access parent coaching and support for childcare and for children with special needs.

Self-funded employers can also incorporate a tool that allows employers to reimburse employees for adoption and surrogacy costs.

Overcoming communication, complexity barriers

BCBSM and their partner faced some of the traditional challenges including navigating healthcare’s complexities and connecting members with well-suited providers. But Abraham found that a couple of strategies were very effective at overcoming these obstacles.

First, Abraham underscored the importance of targeting messaging appropriately when informing members about their new benefits.

To connect members with well-suited providers and to strategically target messaging for members who are most likely to need these services, the payer must rely on member data. In the Maven-BCBSM partnership, BCBSM scoured its member data to assess which members were most likely to need Maven advocates.

“We are investing a lot of dollars into being able to analyze that data to find which members need what kind of care or what kind of support,” Abraham shared.

Research shows that when mothers connect with doctors who are of the same race, the health of the mother and children are more assured. Patients tend to rate their patient experience more favorably when their physician is the same race as them, a separate study showed.

Although gender and ethnicity do not always affect quality of care or patient experience, there are situations in which patients benefit from having providers from specific backgrounds or demographics.

Connecting members who are in racial minorities with broader maternal healthcare benefits can improve equitable access to high quality maternal care, but racial and ethnicity data is hard to source.

In order to overcome this challenge, the payer leaned into its health equity efforts to bridge the gaps. BCBSM invested in training consumer-facing outreach employees and callers how to be culturally sensitive about gathering race and ethnicity data.

In addition to combing through member data, the payer kicked off a multi-year communications campaign designed to make members aware of their new benefit options as well as to engage providers.

This led Abraham to his second recommendation for how to overcome challenges with healthcare complexity and connecting members to the right providers: it requires involvement from other stakeholders.

“I'm going to speak for a second about Aji alone: Aji believes that we need to fix the terrible disparities and outcomes when it relates to minority mothers that go through delivery—and that requires everybody, not just Blue Cross Blue Shield of Michigan, but our industry,” Abraham said.

“It's aligning the incentives so that we're paying providers to keep people healthy as opposed to paying for the cost of a bandaid when somebody goes into the hospital or arguing about the cost of a bandaid when somebody goes into the hospital.”

Stakeholder involvement is key for both micro- and macro-level change in maternal healthcare benefits. It can help drive the success of a maternal healthcare program in two ways. First, entities that are close to the member can help channel into the program the members who would maximize the benefits. Second, stakeholders can offer information to the health plan so that the health plan can conduct outreach.

Communication with providers is essential in the effort to introduce new, comprehensive care options for mothers, parents, and children.

“Oftentimes, it's the provider—whether it's the doctor in the ER or their primary care doctor—that members have that first interaction with that's identifying for members that they have some sort of chronic illness or something else that might require some extended or more intensive care,” Abraham explained.

Providers are the natural choice for stakeholder partnerships, but employers are another crucial collaborator. They can play a key role in ensuring that members have, are aware of, and can use their maternal healthcare benefits.

Abraham added offering a range of family benefits could improve employee retention.

“From a business perspective, with the great resignation as people are calling it, employers are looking for ways to keep employees engaged, to keep them working with them. One of the ways to do that, especially as it relates to female employees, is: if you help them through maternity and delivery, they're more likely to return to work if they want to,” Abraham explained.

To leverage that partnership, payers must ensure that employers understand the new package of benefits. Additionally, employers can give their health plans the phone numbers or email addresses of employees who might benefit from the services so that health plans can conduct outreach.

Abraham stressed that alignment between partners—particularly provider-payer alignment—is pivotal to successfully expanding maternal healthcare benefits. This collaborative environment could produce the perfect circumstances for a value-based care agreement.

“It's really one life journey for that mother,” Abraham said. “So we should be looking at it similarly.”

He emphasized the potential of bundling services for delivery and packaging together services outside of the birth. Such a model would allow hospitals and healthcare facilities to focus on delivering care to the mother, instead of getting weighed down in financial complexities.

“When you're able to put a bunch of services together and pay for the whole delivery as one service, potentially it gets the conversation shifted into what we can do to keep the mother and the baby healthy as opposed to arguing about how many different things were used in the delivery,” Abraham explained.

Abraham is not alone in his conviction that value-based care could be key to resolving challenges in maternal healthcare. AHIP has recommended that value-based care agreements could help lower maternal healthcare costs, such as bundling a limited number of services, bundling an entire episode of care for childbirth, population-based payment models, and global budget models

“I'll tell you, we're not quite there,” Abraham acknowledged. “We'd like to get there, but we're not there yet.”