Cain Brothers is a 100+ year old financial services firm with a strong health care experience, now part of KeyBanc. A recent “House Calls” memo and podcast from two company analysts detailed the state of Medicaid, Motherhood and America’s Future: Giving Birth to Better Maternity Outcomes.

Christian Pesci and David Johnson’s in-depth discussion detailed their bottom-line that, “maternity care in the U.S. is in crisis but poised for rapid evolution…(recognizing) that an uncoordinated system with misaligned incentives harms too many individuals, families, and communities.”

They lay out the crisis as follows:

  • Medicaid funds nearly one-half of births in the U.S.
  • The U.S. maternal mortality rate is nearly twice that of all developed countries.
  • Mothers enrolled in Medicaid are under-served, lacking routine preventive services from pre-natal to post-natal care.
  • Medicaid’s payment mechanism doesn’t generally reward continuity of care or on the basis of value and outcomes.

Underlying these outcomes and financial inputs are the fact that in the 1990s, community-based care that paid attention to social determinants and social services shifted to more hospital-based, institutional care with worsening health disparities based on ethnic, racial, and socioeconomic status.

“Medicaid has enough funding to provide comprehensive services,” the analysts assert, but those resources are not allocated in ways that bolster good outcomes for Moms and Babies.

They offer policy and service prescriptions that focus on value-based opportunities, outlining the OB care episode with:

  • Defined events and encounters
  • A fixed population
  • The opportunity to shift care from the hospital to lower cost sites of care
  • The opportunity for providers to increase value by acting as gatekeepers for the patient population – as gatekeepers, being quarterbacks of care directing care to the right place/site/provider at the right time.

This kind of care can be delivered via different business models, from birthing centers and Federally-Qualified Health Centers to hospital-driven-community-linked programs.

Health Populi’s Hot Points:  The current political dialogue — for lack of a better word — inside the U.S. Capitol Beltway on “what is infrastructure?” speaks directly to the maternal and child mortality disparity in America in the context of the COVID-19 pandemic’s shock to women’s healthcare and home economics.

The care economy cannot be easily or rationally separated from the fiscal economy. The first blog post I wrote on Health Populi back when this site launched at Labor Day 2007 was on this very topic — that the huge percentage of gross domestic product the U.S. allocated to healthcare was so linked to the larger macroeconomy that any tweaking of American healthcare would impact the other 85% of the nation’s financial health and wellness (today, more like 80% with 20% going to medical care and related spending).

Other country member of the OECD, such as those shown in the first chart above, allocate more national spending to “social care,” in roughly inverse proportions to that of the U.S. which is more dependent on “medical care” than social care in relatively percentage terms.

The impact of COVID-19 on the U.S. economy both wreaked havoc on health and finances — and in particular, the mental and behavioral health, combined with financial hits, on women more than men in the “She-Cession.”

This is why today, we are witnessing what some labor economists have termed the “Great Resignation,” with one in three working women choosing not to return to the workforce. A key factor in a woman’s choice not to go back to the workplace is lack of childcare experienced in the pandemic. This is President Biden’s mindful choice to provide a childcare tax credit as a pillar in the “soft infrastructure” funding plan.

So many of the points covered in the Cain Brothers analysis will be part of my fireside chat with Sonia Millsom, Chief Commercial Officer of the Maven Clinic. We’ll be featured in Bayer G4A’s upcoming Digital Health Forum on September 9th, 2021 for which you can sign up here.

Our conversation will focus on Women’s Health in a Post-Pandemic World. We invite you to attend and listen in on Sonia’s and my takes from her lens as a health care provider and digital health innovator, and mine as a health economist and futures-thinker working toward health care for all.

As Christian and David conclude in the Cain Brothers report: “Every healthy birth is an event worth celebrating.”

Amen and amen.