Elevance Improves Maternal Health Outcomes at a Time of Crisis and Inequity

As maternal death rates rise for women of color, the Elevance Health Public Policy Institute reports improved outcomes for the health plan's value-based Medicaid interventions.

An autopsy from earlier this month showed that track-and-field star Tori Bowie died from complications during childbirth. While Bowie and her baby died during an unplanned delivery at home, the U.S. Olympic gold medalist was reportedly scared of the care she would receive from the U.S. healthcare system.

"She didn't trust hospitals," said Bowie's agent, Kimberly Holland, in a CBS News report.

"She wanted to make sure that the baby was going to be okay with her being in control."

"Unfortunately, I hear this concern many, many times," said Dr. Nicole E Williams, founder of The Gynecological Institute of Chicago, in the same CBS segment. "All too often, when African-American women are in the hospital, our concerns are not validated."

Unvalidated health concerns can be fatal for all women but particularly Black women. This has been true for a very long time and is hard to ignore in light of disparate maternal health statistics.

More than double the disparity

"Between 2018 and 2021, the number of maternal deaths in the U.S. has almost doubled and the rate of maternal deaths (per 100,000 live births) has increased by 80 percent, with disparities among Black and Hispanic women sharply increasing." This from a May 2023 report from the Elevance Health Public Policy Institute (EHPPI), an internal think tank within Elevance Health that also collaborates with external groups, including academic partners.

Within the 80% are two maternal mortality rates that reflect two very different realities: 32.9 deaths per 100,000 for White women compared to 69.9 for Black women, according to the CDC.

An added factor is the role of Medicaid. The EHPPI report notes that Medicaid "finances over 40 percent of births, with a greater share of births among younger women, those with lower levels of educational attainment, those living in rural areas, and non-white women."

Elevance Health's value-based obstetric programs

To address this reality and help turn all maternal health outcomes around, Elevance Health launched two initiatives with its Medicaid plans: the Obstetrics Practice Consultant (OBPC) Program and Obstetric Quality Improvement Program (OBQIP).

"The idea was, how do we work with our obstetrics providers to improve maternal health outcomes and infant and maternal delivery outcomes in the Medicaid program?" says EHPPI VP Jennifer Kowalski in an exclusive interview with HealthLeaders. "Women who are enrolled in Medicaid have a particularly greater risk of seeing adverse outcomes."

Collectively, OBPC and OBQIP have improved outcomes across four categories (delivery, infant health, access, and cost) and 14 metrics, and saved more than $10 million since 2015. Elevance has a Medicaid presence in 27 states, with OBPC and OBQIP operating in 22.

Different structures, better results

OBPC and OBQIP have two distinct program designs.

Per the EHPPI report OBPC includes Elevance-employed OB Practice Consultants who partner with OB providers to deliver timely and person-centered care (clinical and nonclinical), improve patient-provider experience, and improve affordability.

OBQIP "offers incentives to OB providers for increasing access and improving the quality of care and outcomes for Medicaid members during the pregnancy and postpartum period."

"Providers who participated in both programs tended to have better outcomes on things like primary C-section rates," notes Kowalski.

Some of the strongest collective outcomes (OBQIP + OBPC) included:

• 91% increase in postpartum visits
   
• 22% increase in vaginal births after C-section
   
• 14% decrease in NICU length of stay
   
• 5% decrease in overall birth costs

"Even providers who participated in just one program moved the needle forward in terms of improving maternal and infant outcomes," adds Kowalski. 

Provider enablement and specialized support

As HealthLeaders highlighted in a recent Payer Week exclusive, the Elevance VBC approach includes provider enablement, specialized support, and incentives, particularly for providers willing to take on downside risk.

Provider enablement, per Kowalski, means that Elevance will be the easiest payer for providers to work with.

"The value-based care program is about not leaving providers to navigate on their own, but giving them real-time data exchange, actionable dashboards, and regular communication. Those are just a few examples," says Kowalski.

As for specialized support, the OPQIP dedicated clinical liaisons are another example.

"This isn't a 1-800 number approach," says the VP. "It's not just a focus on member eligibility and how claims get paid. The clinical liaisons help providers think through the latest evidence-based care, help them interpret and act on data, and support health equity issues that impact care delivery."

In 2023, for example, Elevance added a new health equity measure to OBQIP that focuses on hypertension in Black mothers—an important metric for maternal value-based care programs that must deliver value for not just one life, but two.

Encouraging trust between providers-payers

Provider enablement and specialized support are just two ways that Elevance seeks to strengthen provider relationships. If payers and providers don't trust one another, why should a patient trust either of them—especially when mistrust can be tied to disparate outcomes?

HealthLeaders asked Kowalski about this: providers having the comfort and confidence to engage with a health-plan employed practice partner and holding the belief that everyone is working toward the same goal.

"Over time, we have seen providers raising their hand and wanting to do more value-based care programs, wanting to have that partnership," she says, noting the questions the plan asks to maintain those partnerships.

"How can we help ease the handoffs and referrals between providers—the things that the provider might have to navigate independently or that their staff would have to figure out without our value-based programs?"

Prioritizing maternal health beyond Medicaid

Kowalski notes that the Elevance Medicaid outcomes "offer insights for commercially insured populations as well."

"Regardless of a member's plan, [our VBC approach] demonstrates lessons learned for others: to promote the ongoing review of quality measures, apply continuous quality improvement to program design, support provider enablement, and encourage provider use of digital tools for bi-directional communications."

These are timely interventions, particularly for Black mothers and their babies.

And while the EHPPI report stresses that "improving maternal health, and the existing disparities especially among people enrolled in Medicaid, should be a priority in the U.S.," one OB-GYN notes that race trumps all other demographic factors.

"There is a misconception that these disparities are only limited to poor Black people or Black people without resources," says Dr. Veronica Gillespie-Bell—an obstetrician with the Louisiana Department of Health. She is featured in The 1619 Project, Hulu's adaptation of Nikole Hannah-Jones's Pulitzer-Prize-winning project for The New York Times Magazine.

"It doesn't matter if you are socioeconomically advantaged, socioeconomically disadvantaged, you're educated, not educated. The single tying string is being a Black woman."