We’ve all heard that more people started working from home during the pandemic. As it turns out, the number of people giving birth at home rose, too (albeit not to the same extent).

Per CDC data, the percentage of all US births that took place at home rose to 1.26% in 2020, up from 1.03% in 2019. That’s a 22% increase—and the highest percentage of home births since at least 1990, according to the CDC.

But there’s another pool of birthing people who are looking for something in between: They don’t want to go to a hospital, but they may not feel comfortable going into labor at home either. Those patients are turning to one of about 400 freestanding birth centers, which have doubled in number over the last decade in the US, according to the American Association of Birth Centers.

Birth centers are independent healthcare facilities that have a licensed staff and provide childbirth services. They also “were a more popular choice when there were restrictions on visitors and support people at hospitals during Covid,” said Raizy Hines, a certified doula at Doula Support Los Angeles.

Childbirth is a “cash cow” for hospitals. Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, said that childbirth is a “cash cow” for hospitals because it is such a frequently performed procedure.

“From a financial perspective, hospitals do not want to lose this service to at-home delivery,” Bai said.

But it’s impossible to calculate exactly how much hospitals typically make from childbirth and related services because hospitals don’t report revenue broken down by procedure, she said.

Data from the Health Care Cost Institute shows that in 2020, childbirth and pregnancy made up more than 20% of hospital admissions. And Martin said that on average, hospitals are paid about $13,000 per childbirth, though there’s a “pretty wide variation” among facilities. Keep reading here.—MA

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ACOs, or accountable care organizations, seem increasingly like the gold standard for CMS, incentivizing health systems to provide cost-efficient, quality care for an estimated 11+ million patients in 2022. And by 2030, the Biden administration wants all Medicare beneficiaries—numbering close to 64 million in 2021—to have access to “accountable care.”

ACOs are made up of doctors, hospitals, and other healthcare providers who financially benefit when their patients, often those with chronic illness, receive quality care that also controls costs by keeping patients healthier. It’s a win-win for the federal government (and private insurers who support programs similar to Medicare’s) and healthcare professionals, ensuring that “patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors,” as the US Centers for Medicare and Medicaid Services (CMS) explains it.

“In the default system, [the doctor] gets paid simply based on how often they see you,” said Sean Cavanaugh, chief policy officer at Aledade, a company that helps providers band together to create ACOs. “Under an ACO, he or she gets paid based on [whether] you stay well.”

Successful ACOs that Aledade works with pay the company a cut of the shared savings they get back, said Cavanaugh, a former deputy administrator and director of CMS. Nearly all ACOs participating in Medicare’s Shared Savings Program—99%—met the quality standard required to share in those savings, according to CMS. (Those Aledade worked with that earned shared savings got back an average of $248 per patient enrolled in Medicare per year, Cavanaugh said.)

Still, economics can be an incentive or a disincentive to become an ACO. Keep reading here.—MS

A patient’s health isn’t determined by how often they visit the doctor or how well they adhere to their drug regimen. There’s a range of nonclinical and environmental factors that contribute to a patient’s overall health, and those are called the “social determinants of health.”

“Most people think that health is 100% about healthcare—meaning what you can achieve by going to the doctor and getting regular appointments,” said Lynda Flowers, an independent health policy consultant with expertise in social determinants of health. “The literature says that only about 10% to 20% of health is determined by healthcare, which is important, but in and of itself, it doesn’t account for all of the things that impact our health.”

Examples of social determinants of health include access to safe housing, education, and secure financial resources. Exposure to racism, discrimination, and violence also affects health either positively or negatively.

Many health systems have programs to address various social determinants of health.

Medstar Health, which is based in the DC/Maryland/Virginia (DMV) area, partnered with Uber in 2019 to increase patient access to transportation to appointments. The program was implemented after the health system found that patients weren’t showing up to appointments largely because they couldn’t get to the centers.

Children’s Wisconsin, based in Milwaukee, started a program in 1996 called Project Ujima, which “works to stop the cycle of violent crimes through crisis intervention and case management" for children and adults in the community. One of the successes Children’s Wisconsin lists as a result of Project Ujima is “better medical outcomes after injury.” Keep reading here.—MA

Today’s top healthcare reads.

Stat: “New York is considered one of the worst states in the country to be a doctor,” according to Spectrum News 1. (Spectrum News 1)

Quote: “It has to be a perfect storm of events where there’s an impact to the chest wall overlying the heart with just enough force, and what’s most critical is the timing.”—Christopher Madias, director of the New England Cardiac Arrhythmia Center at Tufts Medical Center, on the suspicion that Bills safety Damar Hamlin suffered commotio cordis after a hit during Monday Night Football (NPR)

Read: The NFL’s response to Damar Hamlin’s collapse during the Bills-Bengals game is part of the shifting landscape around athlete mental health. (the Wall Street Journal)

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