Nashville school district leader overhauls maternity benefit pricing

David Hines is the executive director of benefits at Metro Nashville Public Schools.
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David Hines doesn’t believe having a baby should be expensive — so he restructured his benefit plan to ensure parents would pay zero out-of-pocket costs for doctor appointments to start a family.

As the executive director of benefits at Metro Nashville Public Schools, Hines has a reputation for thinking outside the box when it comes to benefit packages. Thanks to his efforts, his school district is able to provide primary care, physical therapy, chiropractic care and more at five onsite clinics. But his latest accomplishment overhauls how employers pay for maternity care.

“I felt like I was getting beat up over our neonatal costs,” says Hines, the 2020 Healthcare Benny Award winner. “And for whatever reason, we would still have eight babies come prematurely, or have other complications that led to the baby being sick. I wanted something that provided quality, value-based care.”

Read more: How our 2020 Benny Award Winners managed employee benefits during COVID-19

Every year, about 250 babies are born to Nashville school district employees, according to the district. Unfortunately, not all of those pregnancies are easy. Hines says he noticed his employee population (79% of which is female) was experiencing more high-risk pregnancies and C-section births than years prior. The average age of school district employees is 32 years old; not far from the average age of 28, when women in the U.S. typically become mothers.

“Unfortunately, it's not uncommon for this population to experience a catastrophic birth where healthcare costs reach as high as $2.6 million per case,” Hines says. “Thus, maternity and neonatal care are some of the highest healthcare cost drivers for the MNPS health plan.”

Hines suspected providing female employees with better care, at a more affordable price, would help lower costs associated with difficult births. Last year, Hines researched alternatives to the district's existing maternity care plan, but couldn’t find what he was looking for. Undeterred, he approached Nashville’s three hospital systems with a proposal: create a maternity care plan where all the costs are bundled into one upfront payment. Only Vanderbilt Medical stepped up to partner with Hines.

“It’s really hard to overstate what an innovator and thought leader David is,” says C.J. Stimson, cancer surgeon and senior adviser to the chief health system officer at Vanderbilt University Medical Center. “It’s inspiring to see someone with his decades of experience be willing to take risks and try new things.”

Hines and Stimson collaborated to create MyMaternityHealth — a maternity benefit that bundles all costs associated with pregnancy and delivery into one price for employers. The price is adjusted based on whether the individual pregnancy is low, medium or high-risk. By eliminating out of pocket costs, employees save approximately $2,500 each time they have a baby, Hines says.

“Keeping my teachers well is a long-term investment,” Hines says. “Imagine what they can do with that extra money they’re not spending each time they have a baby?”

The program was launched at the beginning of the year at the school district and Vanderbilt. So far, the school district’s C-section rates decreased by 7%. Under the program, employees receive concierge service with a dedicated patient navigator; telehealth visits for qualified patients; free educational classes, including lactation and newborn programs; on-demand room service during the hospital stay and 12 weeks of postpartum care.

In addition to in-person care, MyMaternityHealth includes a telemedicine component; employees are mailed a fetal heart tone monitor, scale and blood pressure cuff they can use at home during digital visits. Women with low-risk pregnancies are able to conduct up to eight of their 12 prenatal visits through telemedicine — an option that allows them to practice social distancing during the pandemic.

“It’s a really convenient option in cases where it’s appropriate,” Stimson says.

The bundling doesn’t stop at maternity care; Hines and the Vanderbilt Medical team plan to implement a similar pricing structure for spine surgery, total joint replacement surgery for hip and knee, bariatric surgery and cochlear implants — all of which will potentially have zero out-of-pocket costs to employees. Stimson says other employers have approached Vanderbilt about adopting the maternity program, and possibly others, after seeing the savings Hines was able to achieve for school district employees.

“David wants bold innovation, but he’s actually centered on something achievable and sustainable — that’s a powerful combination,” Stimson says. “As his story goes across the country, people will start demanding this.”

Hines credits the program’s success to teamwork, and encourages his HR peers to have open, honest conversations with their healthcare providers.

“The provider community wants to talk to us and have discussions about the best way to deliver care,” Hines says. “We need to stop treating them like villains and work together to take care of the folks who rely on us.”

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