What Is the 'Payer Scorecard"?
With the establishment of the Patient Protection and Affordable Care Act (PPACA), and the subsequent mandate for insurers to cover breastfeeding support effective from August 1, 2012, insurance companies now have the opportunity to better manage preventive health services and improve health outcomes across the country.
Why grade insurance companies on their breastfeeding support policies at all? With the purpose of the mandate being to improve breastfeeding initiation and duration rates, it follows that mothers should receive lactation counseling support from a provider educated in lactation care. We wanted a way to insure that the care provided is appropriate to each mother’s concern or issue and that each has access to breast pumps that perform appropriately according to her medical or societal needs. Insurers are now tasked with making sure that happens, and that healthcare dollars are spent more wisely and invested in preventive care. We want to bring attention to that and prompt insurers to do even better going forward.
Why We Measure
The National Breastfeeding Center first evaluated how well (or poorly) healthcare insurance companies were living up to their obligations in September 2013, and are now publishing a second evaluation a year later to see how insurance companies have improved (if at all). We continue to see that specific coverage for breastfeeding varies widely across the industry.
In 2013 our research uncovered that policies vary from covering the bare minimum required to comply with the law – coverage of only a manual hand pump and care rendered by existing in-network providers (who may have no training in lactation care) during well care exams – to policies that recognize the importance of improving breastfeeding and cover fully qualified lactation care providers and the purchase or rental of efficacious pumps.
Part of the reason for the variance is due to the vague language contained in the mandate itself. The law states that Payers must cover, at no cost to the patient, “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment”.
However, as the purpose of the mandate is to improve breastfeeding initiation and duration rates, it follows that mothers should receive lactation counseling support appropriate to each mother’s concern or issue, from a provider educated in lactation care. Each mother should have access to breast pumps that perform adequately according to her medical or societal need, to allow continuation of milk production when she is separated from her child.
What We Measure
Our analysis centers on two categories - services and pumps - in which each insurance company is given a score. These two category scores are added together to give a full score and letter grade. The points awarded in each category are based on multiple criteria, with each carrying a different weight.
Data selected for measurement included those policies in effect as of July 31, 2013. Scoring focused on the following criteria:
• Types of services covered (e.g. classes, counseling, home visits, coverage of donor milk etc.)
• Types of provider covered (e.g. existing in-network providers of unknown qualification in the areas of breastfeeding, certified lactation care providers, etc.)
• Types of pumps covered (e.g. manual or electric purchase, hospital grade rental)• Criteria or restrictions on coverage (e.g. premature or compromised infant, etc.)
• Accessibility (e.g. in-network only for services, pumps available only through DME vendors, etc.)
View the 2016-17 press release here.
View the 2015-16 press release here.
View the 2014 press release here.
View the 2013 press release here.
Questions? Please reach us here: firstname.lastname@example.org / 855-777-NBFC
Download the 2016-2017
Download the 2014 Scorecard
Download the 2013
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