Empowering Health Care Consumers

Grantee Name

Building Service 32BJ Health Fund

Funding Area

Empowering Health Care Consumers

Publication Date

November 2022

Grant Amount


Grant Date:

October 2019 - January 2021

The United States is currently facing a maternal health crisis. More than 50,000 American women each year are harmed giving birth, according to the Centers for Disease Control and Prevention.

A recent study found that New York State had the highest rate of maternal health complications in the nation. Causes of high rates of maternal health complications and death—and the staggering racial disparities that undergird them—are multifaceted, encompassing societal, socioeconomic, environmental, community health, and health care challenges. In the realm of health care alone, a lack of adherence to safety measures, excessive use of C-sections, and inappropriate early elective deliveries have led to harmful complications for both mothers and babies. Such unnecessary complications highlight that the majority of maternal health issues—and deaths—are preventable.

Although maternity care is a service that consumers can plan ahead and shop for, drastic variations exist in quality, cost, and outcomes across hospitals. NYHealth reports, “Complications of Childbirth: Racial & Ethnic Disparities in Severe Maternal Morbidity in New York State” and “Variation in Health Care Prices: The Problem Starts at Birth” have documented these variations. It is critical that consumers are able to decide where to seek maternity care, but choosing is difficult because they don’t have access to clear information about their options. These variations also create significant cost drivers for purchasers. For example, the 32BJ Health Fund, the health insurance plan for SEIU 32BJ union members and their families, spent more than $21 million in 2018 on births for its members in New York State. NYHealth awarded the 32BJ Health Fund a grant to create a high-value maternity network for its New York City members, who are predominately lower-wage union workers and people of color.

Outcomes and Lessons Learned

Under this grant, the 32BJ Health Fund:

  • Developed criteria for hospitals participating in the high-value maternity network, including rates of complications, alignment with industry standards for maternity care, and commitment to data-sharing and continuous quality improvement.
  • Released a Request for Information and subsequently selected eight hospitals in New York City and Northern New Jersey to participate in the high-value maternity care network, including at NYC Health + Hospitals sites Elmhurst, Jacobi, and Metropolitan, Mount Sinai West; and Maimonides Medical Center in Brooklyn. As of late 2022, seven hospitals have continued to actively participate in the program.
  • Convened focus groups with 32BJ plan members to gain insight on how they currently select maternity care providers, what information they value in their decision-making, and what information would motivate them to participate in the network.
  • Developed marketing and outreach materials for the 32BJ Maternity Program network that aligned with focus group findings to encourage participation, including a website and mailings to plan members.
  • Enrolled the first plan participants in the 32BJ Maternity Program, helping members choose a provider for prenatal care and a high-quality hospital for labor and delivery, based on transparent quality data. As of late 2022, more than 240 mothers have participated in the program, of whom 100% would recommend the program to others, 98% agreed that the program helps keep costs down, and 95% were satisfied with the program.
  • Published a toolkit, in partnership with the Catalyst for Payment Reform, to help other purchasers, such as private employers, public employee purchasers, and union health funds, replicate the high-value maternity network. It includes practical resources like an RFI template, an assessment tool of baseline maternity care outcomes, options for hospital contracting and benefits design, and templates for provider outreach and communication. It was downloaded more than 100 times in the first month alone, and the toolkit was subsequently promoted in a free webinar.
  • Shared findings broadly at a presentation at the American Public Health Association annual conference and through various media mentions, including in the Wall Street Journal, Bloomberg News, and Gothamist.

Consumers gave important feedback about the information they want and need to make decisions about their maternity care, including that participating hospitals offer access to neonatal intensive care and postpartum care and are committed to no surprise bills. Members and their families valued quality of care over cost, as well as existing relationships with doctors and choice in provider. The 32BJ Maternity Program emphasized these quality-related aspects of the network, while it also expected to lower participants’ out-of-pocket costs to as low as $40 for all prenatal care and labor and delivery costs.

The pilot also demonstrated how purchasers can drive improvements in maternity care to be high-quality, patient-centered, cost-effective, and equitable. Participating hospitals were required to share data on maternal care quality and safety, including by race/ethnicity, that many were not previously sharing with purchasers.  Additionally, the program established a feedback loop between hospitals and consumers, through which 32BJ escalated consumer reports of negative care to hospital leadership. 32BJ also found that interest by other hospitals and providers in participating in the network in the future led to practice improvements.

Despite the promise of the program and interest, other purchasers have been slower to actively adopt similar models. 32BJ approaches health coverage differently than traditional health plans, and it is an unusually effective collaboration between a labor union and to provide affordable, comprehensive, and innovative health coverage to working-class people. Other purchasers have expressed more barriers to implementing similar approaches.

32BJ is committed to continuing the network as a part of its Health Fund benefits and expand enrollment. It continues to conduct general and targeted marketing outreach so that members know about the program prior to pregnancy, including quarterly postcards and emails to members in the catchment area. Although 32BJ successfully designed and implemented the network in the two-year grant period—despite obstacles during the COVID-19 pandemic—it could not fully evaluate the network’s impact and test innovative value-based payment models during the project. Once it captures additional years of claims data, 32BJ plans to conduct an analysis of the program’s impact on maternity care quality, safety, and cost. It is also in the process of securing commitments from participating hospitals for bundled payment arrangements and fixed payments to all providers involved in care, which have been shown to reduce costs and improve quality.

Co-Funding and Additional Funds Leveraged: N/A