This conversation explores the historical context of childbirth, the current state of maternal mortality in the U.S., and the emerging role of doulas in modern maternity care. It highlights the paradox of high maternal mortality rates despite advanced medical technology and discusses how doulas can improve outcomes and reduce costs in the healthcare system.

Tips are provided to strategically leveraging the doula opportunity in risk-based contracting.

Takeaways:

• The integration of doulas into maternity care significantly reduces unnecessary interventions and enhances outcomes.
• Evidence demonstrates that doulas can lower postpartum depression rates, benefiting both mothers and healthcare systems.
• Doulas are increasingly recognized as a strategic component in modern maternity care, facilitating cost savings.

Companies mentioned in this episode:

• Blue Shield Blue Cross

For most of human history, birth wasn't a medical procedure.

It was a community event.

In ancient Egypt, birthing women were attended by midwives and female relatives, offering hands on support and herbal remedies, ensuring that pregnancy was managed with care rather than intervention.

In medieval Europe, childbirth took place in a home where experienced wise women, early doulas, in a sense predicted, provided emotional and physical support.

But here's the catch.

If complications arose, there were no hospitals, no formal medical safety net.

Maternal and infant mortality were staggeringly high.

Fast forward to today and you may assume we've left that behind.

But in the United States, a country that spends more on healthcare than any other nation, maternal mortality rates remain among the worst in the developed world.

It's a paradox.

We have the technology, the hospitals, the expertise.

But our system is failing mothers.

The experience of giving birth in America still carries the same risks of neglect and preventable complications that plagued medieval Europe.

One reason over medicalization, where labor and birth are treated as emergencies rather than natural physiological processes.

Another, financial structures that incentivize costly interventions rather than continuous patient centered support.

Which brings us to today's conversation.

There's a solution, a model that restores the human centered care that existed for millennia while aligning perfectly with modern value based care.

Healthcare economics what's the solution?

Doulas.

They're not just providing emotional support for mothers.

They're reducing unnecessary C sections, improving postpartum mental health, and even saving hospitals money.

A concept that is gaining traction across Medicaid, commercial and employer sponsored health plans.

But how exactly do doulas fit into the business of healthcare?

And what does the data say about their financial impact?

Well, I'm your host, Alex Yarijanian, and in today's episode of the VBCA podcast, we're going to explore the evidence, the economics and the policy shifts that are making doulas a key part of modern maternity care.

Let's start with a sobering reality.

In the United States, maternal mortality rates are the highest among developed nations.

And we're not just talking about statistics.

These are mothers, daughters, sisters, partners whose lives are at risk during pregnancy and childbirth.

The financial burden is staggering too.

Maternity costs.

So maternity care costs the United States over 50 billion annually.

That's with a B.

Yet outcomes continue to lag behind.

For hospitals operating under capitated payment models, the challenge is even more acute.

Every preventable C section adds costs, cutting into fixed budgets.

Postpartum depression and complications drive up readmissions and emergency room visits.

And for hospitals with high risk maternity populations, the financial strain is even greater.

The question is, how do we fix it?

One answer, increasingly backed by clinical evidence and financial modeling, is doula integration.

Now, doulas aren't new.

They've been around for centuries, providing continuous physical, emotional and informational support during pregnancy, labor and postpartum recovery.

What is new is the data.

The data showing their measurable impact, not just on health outcomes and hospital finances.

Take this 52.9% reduction in C sections at a hospital after integrating doula care into a maternity care team 57.5% lower odds of postpartum depression and anxiety among mothers who had doula support 64.7% decrease in postpartum mental health diagnoses for Medicaid covered births when doulas were involved.

That's almost 65% decrease in postpartum mental health diagnosis for Medicaid covered births.

Incredible.

For hospitals and insurers working under capitated contracts, this is a no brainer.

This is significant.

Every avoided surgical birth, every reduced hospital stay, every prevented NICU admission translates to millions of dollars in savings.

And the data keeps adding up.

A Blue Shield Blue Cross study analyzing over 340,000 maternal claims found that doulas had the greatest impact on high risk pregnancies, particularly again among Medicaid beneficiaries and marginalized communities.

The Takeaway Doulas are not a luxury.

They are a cost saving strategy.

Hospitals and policymakers are taking notice.

Right now, Medicaid programs in 11 states plus Washington, D.C.

cover doula services, and at least eight more states are working to expand reimbursement programs.

Federal agencies like CMS are actively encouraging doula integration as part of their prenatal workforce expansion efforts.

And it's not just Medicaid.

Some commercial insurers and employer sponsored plans are launching pilot programs to offer doula benefits.

Hospitals incapitated maternity contracts are partnering with community based doula programs, and managed care organizations are including doulas as part of value added maternity care benefits.

In other words, doula integration isn't just good policy, it's good business.

It's smart business.

So how does it work?

How do hospitals actually profit from doula programs?

Here's fewer C sections, lower surgical costs, higher margins, incapitated models, reduced ER visits and postpartum readmissions.

You have less financial strain on fixed budgets.

So beyond direct costs, there's an opportunity for gain sharing arrangements where hospitals earn financial incentives from payers based on successful maternity care performance.

Readmissions, especially preventable ones, are a substantial cost factor for hospitals, particularly in capitated arrangements.

Doulas directly impact these avoidable costs by improving birth outcomes and postpartum recovery.

So what's next?

If you're a hospital executive, a payer or policymaker, here's what you should be doing right now.

Evaluate Medicaid reimbursement opportunities for doulas in your state.

Partner with community based doula organizations to extend maternity care beyond the hospital.

Integrate doula supported models into managed care and capitated contracts.

Negotiate gain sharing agreements with payers that incentivize lower C section rates and better birth outcomes.

But the reality is, hospitals that embrace value based maternity care will be the ones that thrive.

That's it for today's episode of the Value Based Care Advisory Podcast.

If you found this conversation insightful, take a moment to subscribe, share and leave a review.

I'm Alex Yarijanian and I'll see you next time as we continue to explore innovative solutions in value based healthcare.