Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy

Authors

Katy B. Kozhimannil, University of Minnesota School of Public Health
Amy J. Graves, University of Minnesota School of Public Health
Alexandra M. Ecklund, University of Minnesota School of Public Health
Neel Shah, Harvard Medical School and Beth Israel Deaconness Medical Center
Reena Aggarwal, Ariadne Labs Harvard T.H. Chan School of Public Health
Jonathan M. Snowden, OHSU-PSU School of Public HealthFollow

Sponsor

Medicaid and CHIP Payment and Access Commission (MACPAC) MACP17417T1 Centers for Medicare & Medicaid Services Office of Minority Health-Health Equity Data Access Program Eunice Kennedy Shriver National Institute of Child Health and Human Development R00 HD079658-03

Published In

Medical Care

Document Type

Citation

Publication Date

8-1-2018

Abstract

Background: Nearly half of US births are financed by Medicaid, and one-third of births occur by cesarean delivery, at double the cost of vaginal delivery. With the goal of reducing unnecessary cesarean use and improving value, in 2009 Minnesota’s Medicaid program introduced a blended payment rate for uncomplicated births (ie, a single facility or professional services payment regardless of delivery mode).

Objective: We evaluated the effect of the blended payment policy on cesarean use and costs for Medicaid fee-for-service births.

Methods: We identified births in Medicaid Analytic Extract files from 3 years before and after the 2009 payment change in Minnesota and in 6 control states. We used a quarterly interrupted time series approach to assess policy-related changes in study outcomes, comparing Minnesota to control states.

Outcomes: included cesarean delivery, childbirth hospitalization costs, and maternal morbidity.

Results: Minnesota’s prepolicy cesarean rate (22.8%) decreased 0.27 percentage points per quarter after the policy for a total decrease of 3.24 percentage points, compared with control states (P= 0.01)

Description

Copyright © 2018 Wolters Kluwer Health

Locate the Document

https://doi.org/10.1097/MLR.0000000000000937

DOI

10.1097/MLR.0000000000000937

Persistent Identifier

https://archives.pdx.edu/ds/psu/27122

Citation Details

Kozhimannil, K. B., Graves, A. J., Ecklund, A. M., Shah, N., Aggarwal, R., & Snowden, J. M. (2018). Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy. Medical care, 56(8), 658-664.