Presentation (CTI)

OBJECTIVES: Bundled payment is an evolving alternative payment model globally. In New Zealand, the modular payment system, a form of bundled payment, funds the Lead Maternity Carer (LMC) service, which provides maternity services nationwide. Little evidence exists on the development of modular payments, making it difficult to learn from the model's evolution, improve its implementation, and evaluate it. We set out to answer the question: how and why has the LMC modular payment in New Zealand evolved, and what has emerged from it?
METHODS: We conducted 15 semi-structured interviews with policy experts who held key policy roles across a range of organisations involved with the LMC modular payment system in New Zealand. Participants were selected through purposive and snowball sampling, with diversity in professional backgrounds and sector participation applied in the selection process. Data collection took place between October 2024 and April 2025.
RESULTS: We identified five themes: contractual agreement, policy development, pricing model, practice autonomy, and workforce attributes from the data collected. The results show that the modular payment system evolved into an agreement that serves as an ‘advisory notice’ rather than a contract and was left to develop without a mechanism to track or update it in response to changes in the New Zealand health system. Innovative bottom-up group practices, fragmentation of maternity care, facilitation of vertical health services, practice autonomy, and improved access to maternity care were among the consequences of implementing the LMC modular payment. The contractual agreement, policy neglect, lack of negotiation process, and pricing model were critical factors that have shaped the evolution of the LMC modular payment system in New Zealand.
CONCLUSIONS: These insights are relevant for policymakers in designing a bundled payment model that incorporates workforce preferences.