Using Education, Collaboration, and Payment Reform to Reduce Early Elective Deliveries

This case study 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 report 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.