Doulas and Value-Based Maternity Care: Driving Cost Reduction and Improved Outcomes

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

Episode Transcript

(00:00):
For most of human history,birth wasn't a medical procedure.
It was a community event.
In ancient Egypt, birthingwomen were attended by midwives and
female relatives, offeringhands on support and herbal remedies,
ensuring that pregnancy wasmanaged with care rather than intervention.
In medieval Europe, childbirthtook place in a home where experienced

(00:22):
wise women, early doulas, in asense predicted, provided emotional
and physical support.
But here's the catch.
If complications arose, therewere no hospitals, no formal medical
safety net.
Maternal and infant mortalitywere staggeringly high.
Fast forward to today and youmay assume we've left that behind.

(00:43):
But in the United States, acountry 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, thehospitals, the expertise.
But our system is failing mothers.
The experience of giving birthin America still carries the same

(01:06):
risks of neglect andpreventable complications that plagued
medieval Europe.
One reason overmedicalization, where labor and birth
are treated as emergenciesrather than natural physiological
processes.
Another, financial structuresthat incentivize costly interventions

(01:28):
rather than continuous patientcentered support.
Which brings us to today's conversation.
There's a solution, a modelthat restores the human centered
care that existed formillennia while aligning perfectly
with modern value based care.
Healthcare economics what'sthe solution?
Doulas.

(01:49):
They're not just providingemotional support for mothers.
They're reducing unnecessary Csections, improving postpartum mental
health, and even savinghospitals money.
A concept that is gainingtraction across Medicaid, commercial
and employer sponsored health plans.
But how exactly do doulas fitinto the business of healthcare?

(02:11):
And what does the data sayabout their financial impact?
Well, I'm your host, AlexYarijanian, and in today's episode
of the VBCA podcast, we'regoing to explore the evidence, the
economics and the policyshifts that are making doulas a key
part of modern maternity care.
Let's start with a sobering reality.

(02:33):
In the United States, maternalmortality rates are the highest among
developed nations.
And we're not just talkingabout statistics.
These are mothers, daughters,sisters, partners whose lives are
at risk during pregnancy and childbirth.
The financial burden isstaggering too.
Maternity costs.

(02:55):
So maternity care costs theUnited States over 50 billion annually.
That's with a B.
Yet outcomes continue to lag behind.
For hospitals operating undercapitated payment models, the challenge
is even more acute.
Every preventable C sectionadds costs, cutting into fixed budgets.
Postpartum depression andcomplications drive up readmissions

(03:18):
and emergency room visits.
And for hospitals with highrisk maternity populations, the financial
strain is even greater.
The question is, how do we fix it?
One answer, increasinglybacked by clinical evidence and financial
modeling, is doula integration.
Now, doulas aren't new.
They've been around forcenturies, providing continuous physical,

(03:42):
emotional and informationalsupport during pregnancy, labor and
postpartum recovery.
What is new is the data.
The data showing theirmeasurable impact, not just on health
outcomes and hospital finances.
Take this 52.9% reduction in Csections at a hospital after integrating

(04:03):
doula care into a maternitycare team 57.5% lower odds of postpartum
depression and anxiety amongmothers who had doula support 64.7%
decrease in postpartum mentalhealth diagnoses for Medicaid covered

(04:24):
births when doulas were involved.
That's almost 65% decrease inpostpartum mental health diagnosis
for Medicaid covered births.
Incredible.
For hospitals and insurersworking under capitated contracts,
this is a no brainer.
This is significant.
Every avoided surgical birth,every reduced hospital stay, every

(04:48):
prevented NICU admissiontranslates to millions of dollars
in savings.
And the data keeps adding up.
A Blue Shield Blue Cross studyanalyzing over 340,000 maternal claims
found that doulas had thegreatest impact on high risk pregnancies,

(05:11):
particularly again amongMedicaid beneficiaries and marginalized
communities.
The Takeaway Doulas are not a luxury.
They are a cost saving strategy.
Hospitals and policymakers aretaking notice.
Right now, Medicaid programsin 11 states plus Washington, D.C.

(05:32):
cover doula services, and atleast eight more states are working
to expand reimbursement programs.
Federal agencies like CMS areactively encouraging doula integration
as part of their prenatalworkforce expansion efforts.
And it's not just Medicaid.
Some commercial insurers andemployer sponsored plans are launching

(05:53):
pilot programs to offer doula benefits.
Hospitals incapitatedmaternity contracts are partnering
with community based doulaprograms, and managed care organizations
are including doulas as partof value added maternity care benefits.
In other words, doulaintegration isn't just good policy,
it's good business.

(06:14):
It's smart business.
So how does it work?
How do hospitals actuallyprofit from doula programs?
Here's fewer C sections, lowersurgical costs, higher margins, incapitated
models, reduced ER visits andpostpartum readmissions.
You have less financial strainon fixed budgets.

(06:37):
So beyond direct costs,there's an opportunity for gain sharing
arrangements where hospitalsearn financial incentives from payers
based on successful maternitycare performance.
Readmissions, especiallypreventable ones, are a substantial
cost factor for hospitals,particularly in capitated arrangements.
Doulas directly impact theseavoidable costs by improving birth

(07:00):
outcomes and postpartum recovery.
So what's next?
If you're a hospitalexecutive, a payer or policymaker,
here's what you should bedoing right now.
Evaluate Medicaidreimbursement opportunities for doulas
in your state.
Partner with community baseddoula organizations to extend maternity
care beyond the hospital.

(07:21):
Integrate doula supportedmodels into managed care and capitated
contracts.
Negotiate gain sharingagreements with payers that incentivize
lower C section rates andbetter birth outcomes.
But the reality is, hospitalsthat embrace value based maternity
care will be the ones that thrive.

(07:42):
That's it for today's episodeof the Value Based Care Advisory
Podcast.
If you found this conversationinsightful, take a moment to subscribe,
share and leave a review.
I'm Alex Yarijanian and I'llsee you next time as we continue
to explore innovativesolutions in value based healthcare.