When businesses offer healthcare packages as benefits to their employees, they take on the responsibility of having a direct impact on the health and well-being of their employees through the programs they offer.  There will be lots of changes to our healthcare system in the coming years as more aspects of the Affordable Care Act come online, yet as long as corporations continue to offer employee healthcare as a benefit, they have an influence on the quality of care and how it is delivered.  As stakeholders in the healthcare system, businesses have a responsibility and a financial imperative to ensure that the healthcare access they offer through their insurance programs is going to lead to high-quality care with the healthiest outcomes at the lowest cost.  To do this, they may have to use their best business tools and skills to engage unlikely corporate partners in the healthcare field.

My husband’s company offers us several healthcare plans to choose from as part of his corporate benefits package.  We choose the plan that best suits our needs, but even that statement is somewhat laughable based on the choices that are made available to us.  In the decade that he has worked for this company, our costs of participating in this benefits package have more than doubled, while our coverage has diminished.  We went from paying $400 out of pocket for our first birth to over $1400 for our third, and they were six years apart.  (The first birth was with an epidural, and the second two were totally unmedicated, yet cost more than twice as much – crazy, right?)  Costs of childbirth education and a doula were not covered, yet both services have been shown to improve outcomes and reduce costs.  I had low-intervention births because I prepared in advance and demanded it from hospital staff, not because that type of care was freely offered.  The nearest birth center is an hour and a half away, and homebirth is not covered by our insurance.  Of course, to go outside of this system and pay for maternity care without insurance is even worse.  A relative who did that got slapped with a $10,000 hospital bill that will take years for her to pay off.  We are forced into expensive, poor quality care partially because that is what our employers provide to us as our choice.

The insurance company that manages these benefits is making record profits, but my husband’s company is certainly not getting a great deal from this arrangement, as it is paying more for the service, giving less to its employees, and paying for the poor outcomes both in healthcare bills and lower employee productivity.  The hospitals that provide care in the community where my husband’s corporation is located deliver non-evidence-based services that have a direct impact on the corporation’s bottom line.  Participation in this system contributes to infant and maternal mortality rates that are some of the worst in the industrialized world, and are putting a huge financial strain on our country’s economy.  At what point does it become fair to say that corporations, as major stakeholders in healthcare, have a responsibility to force change within the insurance, hospital, pharmaceutical, and medical industries because they have the resources and the clout to do it in a way that nonprofits and individuals can’t?  I think the time is now.

This means that, for an example, my husband’s employer would have to invest time and money into learning about optimal maternity care.  A good place to start is with Childbirth Connection’s report “2020 Vision for a High-Quality, High-Value Maternity Care System.” Next, they would work with insurance companies to develop benefits packages which offer high-quality, high-value care.  I’m sure there is an insurance company out there that would be happy to work with a Fortune 50 company to develop an innovative maternity care package that provides high-quality, evidence-based care at reasonable costs, with good profit margins because it utilizes lower-cost practitioners.  His company could go to the hospitals that serve its employees and work with them to institute midwifery programs, redesign labor rooms to be more conducive to low-intervention birth, and provide training for nurses, midwives, and doctors on collaborative, evidence-based care practices.  It could send its lobbyists to advocate for change in payment for healthcare and tort reform, as well as laws that limit the powers of the hospital, pharmaceutical, and medical industries to influence research and the practice of non-allopathic care while increasing access to midwives and birth centers through legislation.  Also, his employer could support community-based resources such as birth networks, independent birth centers, and nonprofits that provide information and services to expectant and new families, and steer employees towards healthier options through education and improved access.

Through the tools and skills of negotiation, leveraging business relationships, utilization of resources, and government and community engagement, corporations can play a major part in quickly changing the quality of our maternity care system.  It is in their best interest to do so, and it is their responsibility to do so.  As long as corporations continue to take on the role of healthcare payers, it is reasonable for society to expect a high level of corporate engagement in ensuring the system they are paying for produces good outcomes at reasonable cost.