New York City Union Uses Its Size to Leverage Improved Maternity Care – Wall Street Journal

32BJ’s health fund pays for roughly 1,300 births a year, costing almost $23 million. Supporters of the union’s commercial office cleaners marched along Sixth Avenue in Manhattan as part of a nationwide rally on June 12. Photo: Bebeto Matthews/Associated Press

In a bid to provide better health outcomes for pregnant women and reduce health care costs, one of New York City’s largest unions is pushing local hospital systems to create specialty maternity-care networks.

This week, the health fund of Local 32BJ of the Service Employees International Union will request that area hospital systems provide information on rates of maternal harm and apply to a newly created program promising higher quality, higher value care. The union is self-insured through an independent fund, which fully pays and has access to all claims for its 200,000 plan participants, who work in the city’s service sector as cleaners, property maintenance workers, security officers and more.

Hospitals selected to participate in the health fund’s network would commit to better health outcomes for mothers, including lowering the number of women who have unnecessary Caesarean births, episiotomies or suffer other short- or long-term consequences after birth.

In turn, hospitals would be advertised by the fund to its members. Eventually, the plan includes entering into direct contracts with facilities for a bundled rate for labor and delivery services. Union officials hope their plan could serve as a model for other employers that provide insurance.

“We need to do the shopping for our members so that we can identify what the right set of choices is for them to make,” said Sara Rothstein, 32BJ Health Fund Director.

Health-care spending on New Yorkers who get insurance through work is higher and rising more sharply than the national average, according to health-policy experts. About half of the employer-sponsored market in New York state is self-insured, according to David Sandman, the president and chief executive of the New York state Health Foundation. Maternity care can be planned, he said.

“Self-insured employers are sleeping giants who, because they pay such a large share of the bill, could be forces for health care reform,” said Mr. Sandman.

Already, the 32BJ health fund has direct contracts with Mount Sinai Health System to provide care for joint replacement and bariatric surgery. A Mount Sinai official, Niyum Gandhi, said the arrangements have been a “win, win, win” for the fund, members and the hospital system. The fund has saved money, members get quality care, and “we’re rewarded with a higher market share,” he said.

Based on those contracts, said Ms. Rothstein, it was time to take a closer look at care for expectant mothers. 32BJ’s health fund pays for roughly 1,300 births a year, costing almost $23 million.

In crunching claims data, the fund’s analysts found that the cost of a vaginal delivery in 2017 at New York City hospitals ranged from $10,549 to $30,105 for participants. Birth by Caesarean delivery for the same period and region ranged in cost from $16,073 to $40,118.

Health outcomes from the births varied. While a severe maternal morbidity rate for participants was in line with averages for all of New York City, the health fund’s analysts found that the episiotomy rate for health fund participants was greater than 25%, roughly double the statewide rate. According to a widely used target rate, an episiotomy should only occur in 5% of births.

According to 2017 data from the Centers for Disease Control and Prevention, the C-section delivery rate in the U.S. is 32%. In New York state it is 34.1%, and in New York City the rate is 33.7%. The C-section rate for 32BJ Health Fund participants is 41% in New York.

Ms. Rothstein said that while they don’t keep track, expectant mothers in the health fund are largely low-wage workers and women of color.

Studies show that this population is at an increased risk for harm during labor and delivery, according to experts. Several local and state initiatives have in recent years attempted to improve outcomes for this population of mothers, including expanding access to doula support, prenatal home visits and the use of midwives, said Nan Strauss, director of policy and advocacy for the nonprofit Every Mother Counts.

“There’s an incredible opportunity in this particular area of medicine and health care,” said Ms. Strauss, “but it requires a systems change.”

Write to Melanie Grayce West at

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