Milbank Supported Report on Improving Birth Outcomes

November 7, 2013

A new case study released by Catalyst for Payment Reform (CPR) with support from the Milbank Memorial Fund shares the story of South Carolina’s Birth Outcomes Initiative (BOI).

The case study, Using Education, Collaboration, and Payment Reform to Reduce Early Elective Deliveries, chronicles how South Carolina’s Department of Health and Human Services, South Carolina’s largest commercial health plan, and many other stakeholders partnered to engage providers in quality improvement activities, and then agreed together to stop paying for early elective deliveries—those occurring before 39 weeks gestation. Early elective deliveries are associated with worse health outcomes for infants and mothers and higher health care costs. Despite the overwhelming evidence against early elective deliveries, an estimated 10 to 15 percent of babies in the United States continue to be delivered early without medical cause.

The South Carolina BOI has so far reduced unwarranted early elective inductions by 50 percent, decreased neonatal intensive care unit admissions, and saved the State’s Department of Health and Human Services more than $6 million (in just the first quarter of 2013). South Carolina is the first state in the nation in which the Medicaid agency and the largest commercial insurer have collaborated to establish a policy of nonpayment for early elective deliveries.

The Milbank Memorial Fund provided financial and editorial assistance for the project. “There is an enormous benefit-to-cost ratio from implementing policies that reduce early births; but that implementation is challenging,” said Christopher Koller, president of the Milbank Memorial Fund. “This report details the importance of leadership, evidence and collaboration and provides valuable lessons for state policy makers and private sector purchasers. We are eager to share it with our stakeholders and appreciate the collaboration with CPR.” To download the case study, click here.