Steve Calvin M.D. on pregnancy care, health care reform, and innovation

Are larger integrated systems and ACOs going to “bend the cost curve”?

The folks at Catalyst for Payment Reform recently released a very helpful study on health care market consolidation and the effect on medical care prices.  An executive summary can be found here:

http://www.catalyzepaymentreform.org/uploads/Market_Power_Executive_Summary.pdf

I am convinced by their argument that consolidation of providers (hospital systems in particular) has caused and will lead to further price increases.   There is no question that integrated systems have the potential to increase the value of care but as we move down the road to large accountable care organizations we need to be vigilant.  I know from experience that the rise of lower-cost/high quality alternatives can be an annoyance to these large organizations.

As midwife colleagues and I have developed a true primary midwife-directed pregnancy care model (with free-standing birth centers as an option for low-risk mothers) we have had some interesting experiences.  A leader in a large local system asked, “What would it take for you to just give up on this idea?”.  I later thought that I should have told her that the end of the world might dissuade me.  We have also been told that one of the systems would be happy to have a midwife-directed birth center in their new hospital if we would just raise 7 million dollars in the community!  We declined that advice and went ahead and built a thriving birth center practice for 85% less.

The point here is that some of the best options for care are lower in cost.  The truth is that we aim to break the cost curve while providing the best pregnancy care possible.