Hospitals with capitated contracts saw a substantial decrease in Cesarean deliveries and postpartum depression/anxiety after including doulas.
Separate research by Blue Shield Blue Cross analyzing a large sample of claims further supports the advantages of doula involvement, especially for those at higher risk for maternal health complications. These findings and strategic implications are discussed along with tools for hospital leaders to implement to remain competitive and fiscally viable.
Introduction
For hospitals navigating the financial constraints of capitated contracts, wherein a fixed sum is received for each patient regardless of individual service costs, the margin for fiscal errors is minimal. Identifying efficient and effective avenues for patient care is imperative. Among various strategies, the integration of doulas has presented measurable financial outcomes worth noting.
Decision makers at hospitals with at least 35% of revenues at-risk, minimal or no maternity engagement partner, and little to no ‘beyond the hospital’ strategies for high-risk pregnancy episode management for a fully capitated membership, must reconsider their strategic outlook.
The Fiscal Challenge of Capitated Contracts
Operating under a capitated contract system implies high financial stakes. Hospitals must offer consistent, high-quality care while remaining within a fixed budget. Any additional expenses, especially those arising from preventable readmissions, impact the bottom line. As such, introducing cost-saving measures that maintain or improve patient outcomes is not just ideal—it's essential.
Financial Implications of Doula Integration
Doulas, traditionally associated with childbirth support, are now extending their roles to other healthcare sectors, including playing a bridging role as postpartum patients return to traditional primary care. This broadened role is not just beneficial to patients but to hospitals' fiscal health. Here's how:
1. Costs Reduction: Alex Yarijanian, a leading healthcare expert, makes salient the point that "Readmissions, especially preventable ones, are a substantial cost factor for hospitals -- particularly so for hospitals in capitated arrangements.” Payers have come to realize that doula care leads to fewer cesarean deliveries (which are associated with fewer readmissions than vaginal births), reduced ER visits and inpatient admissions for postpartum depression/postpartum anxiety. Another study found a 64.7% reduction in the odds of PPA/PPD for women receiving doula care during labor and birth which provides a compelling rationale for integrating doulas into healthcare systems, particularly in hospitals operating under capitated contracts. Mounting literature supports these outcomes.
2. Incentives and Enhanced Payments: Hospitals, particularly sophisticated systems, can leverage their maternity care programs by negotiating maternity supplemental payments per live Medicaid birth. The inclusion of doula care can be a catalyst for such payments, adding a financial layer that rewards hospitals for their commitment to enhanced patient care. Gain-sharing arrangements within payer agreements can be explored, potentially resulting in increased Medicaid live birth supplemental payments due to successful maternity care programs utilizing doula support.
3. Optimized Hospital Stay Length: A reduced hospital stay means lower costs. Doulas can influence this by facilitating efficient communication between patients and medical staff, providing support with lactation (a common reason for prolonging hospital stay), potentially expediting the healing process, connecting with resources, and helping with care transitions.
Quantifiable Successes
Real-world data bolsters the financial argument and business case justification for doulas. In one instance, a hospital operating under capitated contracts reported a 52.9% lower odds of Cesarean delivery and a 57.5% lower odds of postpartum depression/postpartum anxiety after integrating doulas into their care system. Asim Malik emphasized, "While these figures speak for themselves, it is important to appreciate how they translate to significant institutional influence, stability, and longevity across operational, financial, and strategic domains."
Research conducted by organizations linked to Blue Shield Blue Cross, which analyzed the claims of 340,010 women aged between 12 and 51, found that services covering a minimum of four prenatal visits, assistance during labor and birth, as well as up to four post-birth check-ups, indicate that the involvement of doulas could reduce negative health outcomes for mothers. This is especially true for women with sociodemographic and medical backgrounds that result in a
higher likelihood of maternal health complications. The evaluation of the data from a substantial segment of Medicaid beneficiaries highlighted a 64.7% drop in instances of postpartum depression and anxiety. Furthermore, hospitals and health services that offer primary or other outpatient care see additional advantages.
Mahmee, a company providing wraparound services to close the gaps in maternity care for health plans and systems, is a vocal advocate for doula integration. Melissa Hanna, CEO at Mahmee, mentions, "From a financial standpoint, the long-term benefits of incorporating doulas are undeniable. Doula care as an intervention translates to cost savings and more efficient patient care."
Conclusion
In the rigorous financial environment of capitated contracts, doulas present a tangible solution. Their integration offers clear fiscal advantages, making them not just a healthcare choice but a strategic financial one. Hospitals aiming to optimize their financial performance under capitated contracts would do well to consider the measurable benefits doulas bring to the table.