As alternate payment methods are tested and spread throughout the country, it is critical to determine ways to align hospitals and physicians both clinically and financially. Maternity care seems an ideal topic to integrate care processes between hospitals and physicians. In particular, low-risk C-section rates show wide variation and if both clinical improvement programs and financial incentives could work towards more appropriate utilization of C-sections, perhaps greater improvement will occur than if each “lever” were used independently.

Cynosure participated in a bundled payment program for Maternity care in a pilot phase in California. The program calculated a “blended rate” for hospitals of the costs of a standard vaginal delivery along with those of a C-section delivery. Four hospitals and health plans agreed to contract for care at a privately negotiated blended rate for all deliveries as well as embark on an expert supported QI program to implement clinical changes intended to reduce C-sections.


The project was developed in partnership with the Pacific Business Group on Health (PBGH) and the California Maternal Quality Care Collaborative (CMQCC) with funding from the Robert Wood Johnson Foundation.