One of the most dramatic turnarounds in modern medical practice was recently brought about by businesses mainly unrelated to healthcare. Earlier this month The Leapfrog Group, a nonprofit hospital quality watchdog group, published the results of their voluntary hospital survey which showed a major drop in early elective deliveries; inductions or cesarean interventions before 39 weeks of gestation without medical necessity. According to their March 3, 2014 announcement, since The Leapfrog Group began publicly reporting on early elective deliveries the rate has dropped nationally from 17% in 2010 to 4.6% in 2013. This change represents millions of dollars in healthcare savings, and reduces the incidence of illness and injury to mothers and babies. The success of this reporting process offers an opportunity for businesses to rapidly affect changes to maternity care with dramatic life-saving and cost-saving improvements.
The Leapfrog group was founded by businesses looking to leverage their purchasing power towards creating improvements in the safety, quality, and affordability of healthcare by breakthrough, or “leapfrog” advances. The Leapfrog group recognizes that healthcare purchasers need transparency in order to make informed buying choices. It collects data on clinical outcomes and makes that data publicly available so that customers, from individuals seeking out a hospital where they can have their baby, to multi-national corporations, who will pay for that care through employee benefits, can make informed purchasing choices.
Maternity care is a target ripe for reform, as Americans pay twice as much for maternity care as many other countries and have some of the worst clinical outcomes in the industrialized world. The success in the initiative to reduce early elective deliveries has brought about impressive cost savings and helped mothers and babies stay healthier during birth; South Carolina saw a $6 million savings in Medicaid costs in the first quarter of 2013 by refusing to pay for early elective deliveries. Private insurers, mostly businesses, likely saw similar savings since about half of all births are paid for by private insurance, and private insurers were included in the roll-out of the state-wide initiative.
While continuing its work around reducing early elective deliveries, the next effort The Leapfrog Group will focus on maternity care will be reducing elective cesarean deliveries that occur after 39 weeks. The cesarean rate in America is over 33%. According to the World Health Organization, the highest cesarean rate should be below 15%, otherwise the risks of surgery outweigh the benefits to mothers and babies.
Our high rate of infant prematurity is tied to the rate of elective cesareans, and the medical and economic costs of prematurity are ongoing. There are many opportunities for improvement. Cesareans cost almost twice as much as non-surgical births, and late-term prematurity can be avoided by stopping the practice of elective cesarean deliveries. The potential cost savings to corporate insurance payers could have a dramatic effect on their bottom line.
Businesses can help to make these “leapfrog” breakthroughs in maternity care reform by participating in local and regional business groups on health. They partner with The Leapfrog Group to urge local hospitals to voluntarily report their clinical outcome data as part of the Leapfrog Hospital Survey. According to Erica Mobley of The Leapfrog Group, the locations which have the most dramatic change in outcomes tend to be the ones where the business community has been active in encouraging participation in the survey. Business groups on health utilize their existing relationships with administrators and hospital corporations to leverage change. Where industry has not stepped in to apply pressure on local hospitals, less change has been made. As the case of South Carolina shows, the benefits of participation can be substantial to businesses, local workers, and families.
Reducing early elective inductions is viewed as “low-hanging fruit” of maternity care reform, while reducing elective cesarean deliveries is considered to be a more complicated process. The reason is that the decision to do a cesarean is made at the level of the healthcare provider and studies show great variability in c-section rates from doctor to doctor, even within a single facility. Hospitals are reluctant to dictate practice guidelines so strongly for fear of alienating the doctors who work within their walls. To advocates for maternity care reform, provider level transparency is the Holy Grail, as it would allow for the ability to compare doctors’ clinical outcomes and lead to improvements in obstetrical practice by weeding out the low-performing doctors or forcing them to improve their outcomes. Outside pressure will be needed to encourage true transparency down to the provider level, which would allow for the most effective change to take place.
As recent events at AOL demonstrated, businesses that offer health benefits to employees become inextricably connected to their families by paying for the births of their children. There is a strong tie between access to evidence-based, optimal maternity care, corporate benefits packages, and healthy outcomes for mothers and babies.
Business leaders know that success breeds success. The effectiveness of transparency and public reporting on reducing early elective deliveries has shown that corporate involvement in healthcare transparency initiatives can bring about rapid improvements. Participation in regional business groups on health that partner with The Leapfrog Group and other like-minded organizations is the pathway to moving entrenched healthcare systems towards transparency for the benefit of the community. That is the definition of “good business.”