Transforming Maternity Care Part II

At last week's landmark gathering of childbirth, legal and insurance experts from around the country for "Transforming Maternity Care: A High Value Proposition," there were great ideas on how to make care more evidence-based. (Also interesting people spotting. There was Marshall Klaus, the doctor who did groundbreaking research on bonding, standing next to supermodel Christi Turlington, who is working on a documentary on maternal mortality...) But I digress.

In the blog post below I talk about insurance payments being used as a carrot and stick to influence methods of care -- to make them the right ones at the right time.

Today, let's talk about how the threat of malpractice influences care and how to change that.

Many panelists suggested setting up a financial system for disastrous outcomes that are no one’s fault (Sweden and New Zealand are models for this). The system should also incentivize having obstetric teams practice emergency situations to earn a reduction in malpractice insurance premiums, something already being done in Boston’s Harvard system. Another idea: Establish “apology” laws so providers can express remorse without admitting malpractice.

Aside from tackling malpractice issues, we also need to find legislative options to fix the disjointed system of health information technology, or HIT. Only 17 percent of American hospitals have such systems, but the number is expected to grow. HIT won’t work if we just digitize patient information; we need to embed performance measurements and code information better to enable data collection. One panelist noted that in the UK, women carry their own medical records for maternity care – “no they don’t lose it,” she said, explaining how the practice is a symbolic shift of authority that seems antithetical to the US system.

Other suggestions that came out of the conference:
--Develop national measures for birth outcomes, something necessary to accomplish the above.
--Look at what other countries are doing right (for less cost and better care).
--Within health plans, foster transparency and access to caregiver choice (ie. midwife, doula, doctor, etc.)
--Increase cultural competency as we rapidly become a nation of minority majority.