Homebirth advocate/expert willing to present advantages of coverage to self-funded NYC company?

[Teacup9]

I know and am associated with an NYC company that is self-funded and therefore can exclude homebirth from their coverage (which they do). They are open to having someone knowledgeable about the cost effectiveness (something that can assure them that homebirth is overall cheaper, because it doesn't result in extra emergency/nicu fees). I know I can print out study upon study, but they need a more standard presentation like they probably get from big money health industry types.

So does anyone know of a someone who does this? Although I can pay the person something, this person would really just have to care enough about homebirth to do it. NYC homebirth midwives seem very busy and although this would encourage business from a larke 5000 employee company it seems like NYC homebirth midwives fill up every month rather than search for clients.

[rixafreeze]

I'm definitely knowledgeable about this and have the credentials to go with it (PhD with specializations in the history of medicine, maternity care, & childbirth).

My own college, also self-funded, agreed to cover home birth at my request a few years back. It my case, it was really easy to make the change. The college is small enough that most people know each other, and the HR person was really supportive. We've had a few faculty members have home births covered under the new plan. She also changed our policy to cover medically indicated varicose vein treatment, also at my request. I think I'm finally going to get my veins fixed after this pregnancy.) 

The biggest problem is that I don't live nearby! But do keep in touch and let's see how I can help.

Dr. Rixa Freeze

Stand and Deliver

[Roanna Rosewood]

Rixa and "Teacup9", 

I'm excited about this conversation :-) Did you know that over 50% of American employees who have employer-provided health insurance work for companies that design and insure their own health benefits. In other words, if we can make this case not just to Teacup9's company but on a broader scale, we can create real change! Imagine what will happen when companies realize they can save money by supporting midwifery! Lets do this in a way that others can access it. Rixa, that you were able to do this with your college is a big deal! Is it possible for your college to quantify the savings? Can you share with us what this process was like? What their concerns were? Could you maybe do a youtube talk on it? Will you be a guest on www.birthplanradio.com episode to talk about this? As part of our program, we ask listeners to take action which could be to share the youtube video along with some sort of white pages with qualified employers? If we approach this from a national action perspective, it might be easier to get other big voices involved. What do you think? Please email me at [e-mail] if you are willing to discuss this. Teacup9, if you are looking for someone local to make a live presentation, I wonder about a local midwifery group like http://www.nycmidwives.org/ ?  Maybe help them see that this doesn't have to be about your company but about supporting midwifery through the entire state. But that suggestion isn't made to blow off your request, just to brainstorm how we can make this work. 

Roanna

www.birthplanradio.com

www.roannarosewood.com

[rixafreeze]

So I have lots of ideas of where you'd need to start to make this presentation. This would be really fun to do...maybe we can find a way to get me out to NYC ! But in any case, here's the information you'd need to gather:


1. Call all NYC home birth practices and ask:
a. their fees (usually a global fee for prenatal care, birth, and postpartum care through 6 weeks)
b. transfer rate (urgent vs. non-urgent, if they have that info)
c. cesarean rate
d. epidural rate
e. NICU admittance rate & average length of NICU stay
f. breastfeeding rates at 2 days postpartum

2. Call all NYC and maybe other area hospitals (as many as you can manage) and gather the following information:
a. Average cost of vaginal birth (if they have data for uncomplicated vs. complicated VB, even better)
b. Average cost of cesarean birth
c. Most current cesarean rate
d. Breastfeeding rates at hospital discharge
e. Average cost of newborn stay (since this is usually separate from the birth fees)
f. epidural rate
g. NICU admittance rate
h. average length of NICU stay

Keep in mind that home birth fees are a global package including prenatal and postpartum care, while hospital fees are only for the hospital stay, not prenatal care with the doctor or midwife. A-E of # 2 are most important to obtain. I don't know how hard it will be to get these numbers; you might need someone with credentials to make the call. I've done this before to hospitals in Iowa when I was a graduate student and researching costs of hospital maternity care.

Then you'd want to look through some of the high quality home birth studies and tease out the following information:
- cesarean rate
- transfer rate (urgent vs non-urgent)
- % of babies requiring NICU stay

I'd suggest looking at data from the CPM 2000 study in the BMJ, the Canadian studies from BC and Ontario (these compared midwife attended births at both home and hospital and physician-attended low risk births in hospitals), and the large Dutch home birth study. This will give us a good picture of transfer rates, NICU rates, and cesarean rates among planned home births. The Dutch data will be a bit farther off because their transfer rate is much higher than in North America, probably because home birth and midwifery is so much more integrated into the system (and thus it's much smoother to transfer care there than in North America).

With those numbers, you can do some preliminary calculations of the costs involved with home birth, including ones that require transfer to a hospital.

Rixa

[rixafreeze]

ps--I know that it's hard to compare home birth practice stats with overall hospital stats (obviously, there are different risk categories involved) but that's where the Canadian & Dutch studies can really clarify how home birth compares to low-risk hospital births with either midwives or doctors. So you can tease that out as well during your presentation, since there might be questions about that.

[MeepyCat]

So, not to say that employees shouldn't talk their employers into providing better benefits, but can I just say how much I hate the pro-homebirth arguments that are based on cost?  Because what those arguments boil down to, basically, is an argument for providing pregnant women with *less*.  Less care.  Less access to hospitals, doctors, and resources.  When I considered homebirth for myself, I was considering the possibility that homebirth might be better for me and my child - happier, more in harmony with our lives, and hopefully safer.  My last two pregnancies, unfortunately, were not well-suited to home-based care.  I had a miscarriage, followed by an otherwise healthy pregnancy with complete previa.  I needed hospitals and doctors, and if I were to have another pregnancy, I would choose hospital care again, from the start, hoping not to need the full arsenal, but much more comfortable having it at hand.

Homebirth midwives in the United States are not integrated into the health care system the way they are in the Netherlands and Canada.  As a result, women who chose homebirth in the U.S. simply do not have the same access to obstetrical care as they do elsewhere.  This gap can be extremely dangerous for women and babies.  Some families address this challenge by seeking shadow care (which is an additional cost), others wind up in the ER and the NICU with complications that could have been treated earlier and better, or prevented altogether, on the L&D unit.

While I understand the pull of homebirth for many many families, and I support the rights of women to birth at home if they choose to do so, I think access to hospital care is vital for the health of women and infants, and care should be taken in framing pro-homebirth arguments, so that those arguments don't put pressure on families to avoid hospitals.  It is fundamentally extremely problematic to support a low-tech care option because it is cheap - in health care, we shouldn't have to make do with what's cheap, we should be able to consider the specifics of our personal situations, and seek what is *best*.

[Roanna Rosewood]

I don't want to discourage all of that important work but if a simpler angle is needed, you might want to check out http://mamacampaign.squarespace.com/storage/Summary_of_WA_State_Study%20new%20logo1.pdf which details the cost savings for Washington State who is working to double out of hospital births in the next 2-3 years. See http://www.huffingtonpost.com/john-weeks/homebirth-david-versus-th_b_1372854.html. Finally, though I don't have powerpoint, I'm guessing that this presentation http://www.mamacampaign.org/mama-presentations/ might make the case. 

[Roanna Rosewood]

MeepyCat, 

I agree that women shouldn't be put under pressure to avoid hospitals. I advocate for home birth because I believe that women should be able to give birth wherever they want to and because what we are doing in the states isn't working. We spend more than any other country in the world on maternity care but our odds of dying are greater here than in 49 other countries. Keeping home birth an option isn't only about satisfying the 1% of the population that chooses home birth, its about assuring that hospitals do not overstep their power. Because when women have the right to walk out of a hospital, (In some cases they literally don't. See our upcoming episode on www.birthplanradio.com to learn more.) hospitals have competition and incentive to increase quality of care and patient satisfaction. I don't advocate for home birth because it saves money. But it would be foolish to ignore the cost savings involved when talking to businesses.  

[rixafreeze]

I agree that choosing home birth (or hospital birth) should not be primarily about cost. In a perfect world, every option would be freely accessible to every woman, so she could really choose the best provider & location for her situation. But yeah, we live in the real world with HMOs and PPOs and all those annoying restrictions on our health care.

But this insurance company wanted to know specifically if covering home birth would lead to increased or decreased costs. For insurance companies, it's all about the bottom line. If you can use the financial angle to convince insurers to cover home birth as an option, then I say go for it.

[rixafreeze]

ps-Roanna, for me, the process was incredibly simple to get home birth covered. I simply called my university's benefits person and explained that our company (CIGNA) only covered midwives under "direct physician supervision" and only if they worked in a hospital setting. I explained that my nurse-midwife was a licensed health care provider in the state and asked that they change their plan to cover any licensed midwife and take out the hospital-only clause.

I was also 37 weeks at that point. I had been assured multiple times by CIGNA and even got a pre-approval letter from them, then CIGNA had informed me last-minute that they wouldn't cover my CNM at all. Yes, just a tad bit stressful! The benefits person got the plan changed within a week or two and even added my CNM my name to our plan. Awesome!

[mama24-7]

Originally Posted by MeepyCat 

So, not to say that employees shouldn't talk their employers into providing better benefits, but can I just say how much I hate the pro-homebirth arguments that are based on cost?  Because what those arguments boil down to, basically, is an argument for providing pregnant women with *less*.  Less care.  Less access to hospitals, doctors, and resources.  When I considered homebirth for myself, I was considering the possibility that homebirth might be better for me and my child - happier, more in harmony with our lives, and hopefully safer.  My last two pregnancies, unfortunately, were not well-suited to home-based care.  I had a miscarriage, followed by an otherwise healthy pregnancy with complete previa.  I needed hospitals and doctors, and if I were to have another pregnancy, I would choose hospital care again, from the start, hoping not to need the full arsenal, but much more comfortable having it at hand.

Homebirth midwives in the United States are not integrated into the health care system the way they are in the Netherlands and Canada.  As a result, women who chose homebirth in the U.S. simply do not have the same access to obstetrical care as they do elsewhere.  This gap can be extremely dangerous for women and babies.  Some families address this challenge by seeking shadow care (which is an additional cost), others wind up in the ER and the NICU with complications that could have been treated earlier and better, or prevented altogether, on the L&D unit.

While I understand the pull of homebirth for many many families, and I support the rights of women to birth at home if they choose to do so, I think access to hospital care is vital for the health of women and infants, and care should be taken in framing pro-homebirth arguments, so that those arguments don't put pressure on families to avoid hospitals.  It is fundamentally extremely problematic to support a low-tech care option because it is cheap - in health care, we shouldn't have to make do with what's cheap, we should be able to consider the specifics of our personal situations, and seek what is *best*.

Bolding mine.  What evidence do you have, beyond anecdotal, that the expensive, untested tests, procedures & the like with often misused results, result in healthier women & babies?   All the evidence I've seen results in just the opposite.  You may not like the argument that non-ob care is less expensive, but the reality is that it is for a whole host of reasons.  

Where does the OP say anything about denying mothers who want/need more advanced care (which is what most mothers-to-be get in the typical scenerio whether they need it or not) because some will want midwifery/less costly/less invasive care?  

My understanding of the OP is that she would like assistance in helping her company to see the feasiblity of allowing it's participants to choose midwifery care/homebirth.  

Anecdotal evidence can be used in just about any situation to *show* why something needs to happen or needs not to happen.  I'm thinking of it as justification for circ'ing a baby, performing hysterectomy on a woman, using a seat belt, not using a seat belt, etc.

Originally Posted by Roanna Rosewood 

MeepyCat, 

I agree that women shouldn't be put under pressure to avoid hospitals. I advocate for home birth because I believe that women should be able to give birth wherever they want to and because what we are doing in the states isn't working. We spend more than any other country in the world on maternity care but our odds of dying are greater here than in 49 other countries. Keeping home birth an option isn't only about satisfying the 1% of the population that chooses home birth, its about assuring that hospitals do not overstep their power. Because when women have the right to walk out of a hospital, (In some cases they literally don't. See our upcoming episode on www.birthplanradio.com to learn more.) hospitals have competition and incentive to increase quality of care and patient satisfaction. I don't advocate for home birth because it saves money. But it would be foolish to ignore the cost savings involved when talking to businesses.  

BOlding mine:   And, I'd never thought about it being competition for hospitals & thus a motivator for them to improve.  I think a lot more women would have to be making that choice for hosptials/OBs/etc. to stand up & take notice, but maybe in 10+ years?

Originally Posted by rixafreeze 

I agree that choosing home birth (or hospital birth) should not be primarily about cost. In a perfect world, every option would be freely accessible to every woman, so she could really choose the best provider & location for her situation. But yeah, we live in the real world with HMOs and PPOs and all those annoying restrictions on our health care.

But this insurance company wanted to know specifically if covering home birth would lead to increased or decreased costs. For insurance companies, it's all about the bottom line. If you can use the financial angle to convince insurers to cover home birth as an option, then I say go for it.

   

OP - good luck w/ this endeavor!  I'd be interested to hear how it works out .

Sus

[Roanna Rosewood]

mama 24-7, 

Maybe "competition" wasn't the best word-choice. It's about power. When women don't have the right to walk out of a hospital, hospital staff is 100% in control because there is literally no alternative for the mother. As long as the mother retains the right to walk out of the hospital, providers are forced to, on some level, communicate with them instead of (like children) making decisions for them. You can hear human rights attorney Hermine Hayes-Klein talk with Ina May Gaskin about this dynamic at http://traffic.libsyn.com/birthplanradio/Ina_May_Gaskin.mp3 

[MeepyCat]

What evidence do you have, beyond anecdotal, that the expensive, untested tests, procedures & the like with often misused results, result in healthier women & babies?   All the evidence I've seen results in just the opposite.  You may not like the argument that non-ob care is less expensive, but the reality is that it is for a whole host of reasons.

Mama 24-7, I don't disagree that non-ob care is less expensive.  What I'm saying is that women and families deserve the best care, whether or not it's the cheapest.  Failures in care during pregnancy and birth have long-lasting economic effects on families, so direct cost of care is a bad metric anyway.  Who does better for women?  Does home care or hospital care yield better results?  (And does it ever strike anyone else as suspicious that when and only when we talk about care unique to women, "cutting costs" and "empowering the patient" are likely to be treated as synonymous?)

Statistics on home vs. hospital birth are available from a variety of articles, including:

http://www.ajog.org/article/S0002-9378%2810%2900671-X/abstract

https://docs.google.com/viewer?a=v&q=cache:a7cCIiAmRAsJ:www.eventkaddy.com/smfm2012/pdfs/563.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEESicIiRmwFJJ3MNikqd0PfXyrCWutFpVAR2N82Esz6u-ldsrxBBJMx04SlbM9XYw9CApSaPcrV3zg4dSC42vo-8e2XNNRM4QXxkeNAa6e5tjfruuBG4n7Re2cFe58LspCHw_QH9W&sig=AHIEtbQNiwrwpzf4WmzpKGN-w3dzQ_ccJw

http://www.smfmnewsroom.org/2012/02/study-weighs-risks-and-benefits-of-birthing-facilities/

There's plenty of reason to suspect that home birth may not be the safest option for women in general, and we know that it's dangerous for a specific subset of women who face particular risks. 

[newmama13]

@ Rixa- I saw that you were covered by Cigna and I am trying to get them to cover my home birth.  They are only quoting a low rate (similar to a Medicare cost) for my NYS home birth.  Do you have any advise on how to get them to cover a higher rate?  I see in your post from 11/12 that you were able to get in network coverage with help from someone in your HR benefits.  What were you able to reference to get the coverage for in network?