Bundle of JoyTM:
Report 2: The Added Cost of Complications During and After Delivery
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Maternal & Infant Outcomes Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Perinatal Quality Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Data-driven Insights:
The following maternal and infant health trends analysis leverages the Premier Healthcare Database and is used to help hospitals and the nation better understand and target solutions to this national problem. Premier’s analytic capabilities and data assets are used to study specific therapeutic interventions and assess clinical efficacy over time to implement new solutions for unmet medical needs. This is the first of several analyses on maternal and infant health trends.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Perinatal Quality Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Maternal & Infant Outcomes Dashboard:
The industry’s only integrated analytics dashboard enables a comprehensive analysis of an organization’s select perinatal and neonatal data sets, including peer-level and regional benchmarks and individualized reports assessing quality and outcomes. Premier continues to develop innovative analytics solutions to enable hospitals and health systems to benchmark and assess performance against its comprehensive maternal and infant database.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Perinatal Quality Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Performance Improvement Services:
Premier provides one-to-one consulting support as well as collaborative initiatives to advance and scale national efforts to improve maternal and infant health. In July 2019, Premier announced it is working with 10 leading hospitals on a Perinatal Collaborative designed to reach zero preventable maternal and neonatal harm and deaths. Learnings from the collaborative will be shared nationally. In January 2020, the QUEST® quality improvement collaborative will launch a new perinatal specialty network to further test and adopt evidence-based strategies to improve care and the overall experience for women, infants and their families.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Perinatal Quality Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
New Payment Models and Policy:
Premier is working with private and public organizations to test and scale new payment models and reforms to improve maternal healthcare.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Maternal & Infant Outcomes Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Maternal & Infant Outcomes Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Data-driven Insights:
The following maternal and infant health trends analysis leverages the Premier Healthcare Database and is used to help hospitals and the nation better understand and target solutions to this national problem. Premier’s analytic capabilities and data assets are used to study specific therapeutic interventions and assess clinical efficacy over time to implement new solutions for unmet medical needs. This is the first of several analyses on maternal and infant health trends.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Maternal & Infant Outcomes Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Perinatal Quality Dashboard:
The industry’s only integrated analytics dashboard enables a comprehensive analysis of an organization’s select perinatal and neonatal data sets, including peer-level and regional benchmarks and individualized reports assessing quality and outcomes. Premier continues to develop innovative analytics solutions to enable hospitals and health systems to benchmark and assess performance against its comprehensive maternal and infant database.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Maternal & Infant Outcomes Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
Performance Improvement Services:
Premier provides one-to-one consulting support as well as collaborative initiatives to advance and scale national efforts to improve maternal and infant health. In July 2019, Premier announced it is working with 10 leading hospitals on a Perinatal Collaborative designed to reach zero preventable maternal and neonatal harm and deaths. Learnings from the collaborative will be shared nationally. In January 2020, the QUEST® quality improvement collaborative will launch a new perinatal specialty network to further test and adopt evidence-based strategies to improve care and the overall experience for women, infants and their families.
Every new mother and child deserves the best beginning possible, at the most affordable price point. We’re working to make that possible. Premier’s Bundle of JoyTM Campaign is focused on ensuring mothers and babies are always at the center of care, and supported by the latest evidence, the best doctors and the most successful practices.
Premier provides the following resources for healthcare organizations to join us in our campaign to improve maternal and infant health.
+ Data-driven Insights
+ Maternal & Infant Outcomes Dashboard
+ Performance Improvement Services
+ New Payment Models & Policy
New Payment Models and Policy:
Premier is working with private and public organizations to test and scale new payment models and reforms to improve maternal healthcare.
Analyzing the Prevalence of Preventable Complications, their Pre-Existing Risk Factors and the Correlation to Cost
Complications contribute directly to higher healthcare costs.
Cost and Length of Stay
Average Cost | Average Length of Stay | |
---|---|---|
Vaginal Delivery without SMM or Complicating Conditions | $5,681 | 2.3 days |
Vaginal Delivery with Complicating Conditions | $6,691 | 2.9 days |
Vaginal Delivery with SMM | $10,720 | 3.9 days |
Cesarean Delivery without SMM or Complicating Conditions | $8,491 | 3.2 days |
Cesarean Delivery with Complicating Conditions | $10,852 | 4.2 days |
Cesarean Delivery with SMM | $17,927 | 5.6 days |
Average Cost by Delivery Type
Average Length of Stay by Delivery Type
The Most Expensive Morbidity Factors
Incremental Additional Cost per Case of Severe Maternal Morbidity Factors for a Vaginal Delivery
Incremental cost shown is in addition to base cost per case of $5,681 for vaginal delivery without complications or SMM
Incremental Additional Cost per Case of Severe Maternal Morbidity Factors for a Cesarean Delivery
Incremental cost shown is in addition to base cost per case of $8,491 for C-section delivery without complications or SMM
Preeclampsia/Eclampsia and Hemorrhage
By Payer
Chronic Conditions
Cost of Chronic Conditions for a Vaginal Delivery
Cost of Chronic Conditions for a Cesarean Delivery
Behavioral Health
Average Cost of a Vaginal Delivery with a Behavioral Health Disorder
Average Cost of a Cesarean Delivery with a Behavioral Health Disorder
Neonatal Abstinence Syndrome
Learn more about the external factors affecting cost and care variation for mothers and babies, and five ways providers can overcome them.
This is Premier’s first analysis on the cost of maternal healthcare, and its second in its series on maternal and infant health trends, conducted as part of its Bundle of Joy™ campaign. The campaign is designed to test and scale measurable improvement in the quality, safety and cost of care for mothers and babies in the U.S. Premier’s analyses on the key drivers of maternal and infant mortality and morbidity, as well as the costs associated with these trends, will serve as a baseline for measuring hospital improvement.
Methodology
Findings were derived from the Premier Healthcare Database, which Premier used to analyze the cost of delivery for 8.9 million women (approximately 25 percent of births nationally) from 2008 through 2018. Premier specifically examined the hospital discharges of 2.7 million maternal patients treated at 613 hospitals across 42 states from 2015-2018 to drill into cost variation by complications.
Pain Points & Solutions
Business intelligence analytics and insights: Leaders require access to comprehensive clinical data that aggregates risk factors, volumes, outcomes and complications for their maternal population. A perinatal dashboard is a highly valued tool to accomplish this work. With the right business intelligence capabilities, providers collect data, identify patients at higher risk for adverse outcomes and plan interventions, helping circumvent costly complications. The analytics leveraged should be able to assimilate elements from all nationally recognized maternal safety care bundles and incorporate the 80-plus measures that target identified indicators related to harm and death. This is critical to standardize the care that mothers receive and reduce variation in cost irrespective of age, race or payer.
Highly reliable care: Armed with business intelligence and the knowledge of which patients need additional support, hospitals can standardize and customize their perinatal care by developing evidence-based practices, including interventions to address scenarios for high-risk patients as they work toward zero harm. Highly reliable concepts are fully aligned with the nationally endorsed guidelines and strategies. Providers should craft standard care guidelines to incorporate not just the national maternal safety bundles, but also operational and quality measures, including length of stay, readmissions, cost and efficiency, as well as medical indicators for risk factors and other clinical conditions such as preeclampsia and behavioral health protocols.
Technology to enable adherence: As staff and clinicians create and adopt standardized care models and train around them, leaders need to evaluate adherence to evidence-based guidelines – or barriers that are preventing it. Embedding a data-enabled clinical decision support (CDS) solution into the workflow can help support clinicians in delivering real-time, patient-specific best practices that are based directly on the organization’s standardized care guidelines. CDS analytics can also show how clinicians respond to the organization’s point-of-order alerts, demonstrating to leaders the effectiveness of a hospital’s standardized care guidelines. This ensures the right care is provided at the right time, helps improve adherence to evidence-based guidelines and prevents variation that may result in harm and additional costs.
Risk-stratification to support at-risk patients. It’s critical that organizations collect socioeconomic information from patients such as social determinants of health, whether through screening tools or other methods, to help women who may lack the resources to properly care for themselves and growing babies. Using results from risk-stratification, providers should identify and modify care for pregnant women who exhibit risk factors for maternal mortality or morbidity, including obesity; substance or opioid use disorders; heart disease; hypertension; and chronic disease such as diabetes. These conditions can often exacerbate pregnancy-related complications, and left untreated, these conditions can worsen post-pregnancy, resulting in additional care, cost and emotional stress.
Payment models that incent whole-person, value-based care. Because of barriers to healthcare access, women of color, lower socioeconomic status and those living in rural areas are more likely to exhibit risk factors for adverse maternal outcomes, and thereby higher costs for care. As payers introduce financial models that incent providers to coordinate care as efficiently and cost-effectively as possible, risk-stratification will identify women who need more hands-on guidance. Care models that are tailored to specific groups of women based on risk assessments could de-emphasize overmedicalization, such as Cesarean deliveries for low-risk women, and guide more resources toward women who are higher-risk. Progressive organizations are also exploring high-value alternatives, such as direct-to-employer payment models, in which providers strategically coordinate quality care and are less likely to recommend unnecessary and costly interventions15.
Learn more & join us in our effort to improve maternal health
1https://www.npr.org/2019/05/15/723518379/u-s-births-fell-to-a-32-year-low-in-2018-cdc-says-birthrate-is-at-record-level; 2https://journals.lww.com/greenjournal/Fulltext/2017/12000/Disparities_in_Chronic_Conditions_Among_Women.19.aspx; 3https://www.ncbi.nlm.nih.gov/pubmed/30586147; 4https://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf ; 5https://www.ncbi.nlm.nih.gov/pubmed/21668737; 6https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2012.01359_8.x; 7https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_06.pdf; 8 https://journals.lww.com/greenjournal/Fulltext/2017/12000/Disparities_in_Chronic_Conditions_Among_Women.19.aspx ; 9https://pediatrics.aappublications.org/content/141/4/e20173520; 10https://www.ncbi.nlm.nih.gov/pubmed/28612362