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Am J Obstet Gynecol. 2017 Mar;216(3):250.e1-250.e14. doi: 10.1016/j.ajog.2016.12.033. Epub 2016 Dec 29.

Achieving higher-value obstetrical care.

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Clinical Excellence Research Center, Stanford University, Stanford, CA; Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Oakland, CA.
Clinical Excellence Research Center, Stanford University, Stanford, CA; Global Health Sciences, University of California, San Francisco, CA.
Clinical Excellence Research Center, Stanford University, Stanford, CA.

Erratum in


Obstetrical care in the United States is unnecessarily costly. Birth is 1 of the most common reasons for healthcare use in the United States and 1 of the top expenditures for payers every year. However, compared with other Organization for Economic Cooperation and Development countries, the United States spends substantially more money per birth without better outcomes. Our team at the Clinical Excellence Research Center, a center that is focused on improving value in healthcare, spent a year studying ways in which obstetrical care in the United States can deliver better outcomes at a lower cost. After a thoughtful discovery process, we identified ways that obstetrical care could be delivered with higher value. In this article, we recommend 3 redesign steps that foster the delivery of higher-value maternity care: (1) to provide long-acting reversible contraception immediately after birth, (2) to tailor prenatal care according to women's unique medical and psychosocial needs by offering more efficient models such as fewer in-person visits or group care, and (3) to create hospital-affiliated integrated outpatient birth centers as the planned place of birth for low-risk women. For each step, we discuss the redesign concept, current barriers and implementation solutions, and our estimation of potential cost-savings to the United States at scale. We estimate that, if this model were adopted nationally, annual US healthcare spending on obstetrical care would decline by as much as 28%.


birth centers; cost; group care; healthcare redesign; high value care; outpatient birth center; postpartum LARC; reduced prenatal visits; value

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