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    The Perinatal Episode of Care Model: How will it affect you and your high-risk patients?

     

     

     

     

     

    Dr. DeRoche is Medical Director at Greater Nashville Perinatology, Nashville, Tennessee.

     

     

    Dr. Guerette is a Research Psychologist at Greater Nashville Perinatology, Nashville, Tennessee. 

     

    Many healthcare delivery and payment reform options have been proposed to control rising and unsustainable costs, and are being implemented across the country. One such strategy is the state of Tennessee’s episode-based payment model, which took effect on January 1, 2015.1 It comprises 3 initial episodes of care (EOC)—asthma exacerbation, total joint replacement, and pregnancy—and a plan is in place for development and implementation of more than 70 additional episodes during the next 5 years. Several other states are currently considering a perinatal EOC model similar to the Tennessee approach.2,3

    The perinatal EOC is a payment system intended to control costs while focusing on patient-centered, high-value healthcare for pregnant women. The state identified high healthcare costs for infants in the neonatal intensive care unit (NICU) as a significant health and financial issue and determined that the best way to reduce NICU costs was to improve maternal care. The state intends to accomplish this through the perinatal EOC model. The perinatal model will initially affect the deliveries of approximately 80,000 pregnant women covered by TennCare (Tennessee's Medicaid program) and certain Blue Cross/Blue Shield commercial plans. It is designed to control maternal costs by rewarding lower-cost providers and penalizing higher-cost providers. The perinatal model does not consider NICU admission rates or neonatal costs associated with an obstetrician’s deliveries, and it is not known whether controlling maternal costs will result in improved maternal care or lower NICU utilization.

     

    Michael E. DeRoche, MD
    Dr. DeRoche is Medical Director at Greater Nashville Perinatology, Nashville, Tennessee.
    Paula J. Guerette, PhD
    Dr. Guerette is a Research Psychologist at Greater Nashville Perinatology, Nashville, Tennessee.

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