Practice Model

How it works


How do Care Teams enter the System?

Applying lessons learned from others (including challenges commonly encountered when organizations attempt to improve quality of medical services), We prefer to launch new maternity care practices rather than bringing either midwives or physician into an existing practice. There are clear performance benefits from allowing professionals a ‘fresh start’ with aligned vision and incentives. In addition to new practices, we will bring full turnkey care teams into existing organizations such as safety-net systems.

Why has this not been attempted before?

World Health Organization (WHO) which advocates the collaborative physician/midwife model of obstetrical care states: ‘The collaborative MD/CNM model of obstetrical care provides the best obstetrical outcomes.'" Yet, this integrated model of care is well accepted in many countries, including most of Europe but has still to take a hold here in the USA. Prior challenges in the USA have included a lack of the consolidated financial and intellectual capital required to address variations in crucial factors such as level of patient interest, midwife and physician awareness, sophistication of maternal care health systems, and discordant reimbursement for medical services. As USA healthcare reform emerges, our model is well positioned to make a large-scale impact. While there are some small practices popping up here and there, Lucina is the first to attempt this on a large scale and as part of a foundation’s mission.

How will you prove that the Lucina model lowers the total cost of care and increases quality?

From our first practice launch in January 2012 we will invest in the collection and analysis of outcomes data as part of an external validation study guided by national experts. This data will include clinical outcomes that will be compared to a control group matched for patient characteristics. The financial data will be utilized to define the impact on total cost of care for maternal-newborn services.

How will you attract women to this practice/model?

We will draw women from a specific geographic area near each practice using a variety of means including social media, promotion via insurer groups we associate with, and other promotion. This will be our “pull” strategy. To “push” women to this model, we will insert ourselves into standing hospitals such as safety-net systems where we place a care team.

Will only the healthy and “normal” pregnancy be served?

No. A clear strength of this care model is the ability of an integrated team of professional midwives and physicians to provide care for a group of pregnant women who can range from ‘normal pregnancies’ to ‘high-risk pregnancies’. We don’t refer a patient out if she develops complications because the integrated team is present and on-site to handle.

Will you operate only in private Practice?

No. This model is very flexible and high performance, thus very appealing for implementation in the safety net system. As USA healthcare reform emerges, our model is well positioned to make a large-scale impact.

Will you serve the Medicaid population?

Yes. One of Lucina Health Foundation’s core missions is to care for the underserved population. By inserting care teams into a safety net system we are able to make a large-scale impact much needed in this demographic.

Does this model not threaten current OB/GYN's?

No. The threats to private practice OB/GYN are arising from large external factors including complex regulatory and financial requirements. This is an opportunity to collaborate and better enjoy using their medical skills in a more balanced team setting.

Are there enough OB/GYN's willing to collaborate this way?

There will be. As noted above, the current conditions will favor innovation and adaptation.

Are there enough midwives in the system to support this model?

Yes. Although the CNM workforce status varies across the country, California has an excellent talent pool of trained Certified Nurse Midwives.

Where will the midwives come from?

From institutions that are nationally recognized leaders including UC San Francisco.