Medicaid Incentives for Effective Contraceptive Use and Postpartum Care

Unplanned and complex births carry potentially avoidable health complications and costs to families and states. Broad healthcare payment and delivery reform is underway across the country to improve outcomes, enhance patient experience and reduce costs. Some states are capitalizing on these reforms to promote planned and healthy births by driving improvement in effective contraceptive use and postpartum follow up care. Their efforts create potential opportunities for cross-agency collaboration and integrate well with other initiatives, such as the Centers for Medicare and Medicaid Services’ Maternal and Infant Health Initiative and the Health Resources and Services Administration’s Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN).

Alabama, Colorado, Ohio and Oregon are among the states transforming the way they pay for and deliver healthcare across their Medicaid programs to increase accountability for quality and costs among providers and managed care entities. Key elements include performance measurement, reporting and performance based payment for a variety of services, such as family planning and postpartum care. Oregon has an incentive measure for effective contraceptive use, and Colorado and Ohio incentivize postpartum care visits. Alabama also plans to implement Medicaid delivery reform with incentives for postpartum visits.

Oregon has transformed its Medicaid delivery system by establishing a network of coordinated care organizations (CCOs) or community-based health entities responsible for providing integrated healthcare for Medicaid enrollees. The state has incentive measures for which CCOs can earn annual bonus payments. Last year, Oregon introduced an effective contraceptive use (ECU) incentive metric that tracks the percentage of women ages 18 to 50 who use a most or moderately effective contraceptive method.

Colorado has transitioned its Medicaid program into an Accountable Care Collaborative made up of regional care collaborative organizations (RCCOs) that coordinate care for members and contract with primary care medical providers. Medicaid withholds a small portion of the per member per month payment to providers and RCCOs that they can earn back by performing well on three incentive measures. In 2014, Colorado added its incentive measure for postpartum follow-up care use, which assesses the percentage of members who had outpatient postpartum visits following live births.

Ohio’s multi-payer payment and delivery system transformation includes episodes of care. The perinatal episode of care encompasses prenatal care, most delivery-related services and postpartum care. A principal accountable provider is responsible for the quality and cost of care delivered to the patient for the duration of the episode. Depending on average episode costs and performance on specific quality metrics, principal accountable providers may be eligible to receive an incentive payment or be subject to paying money back to the state. The goal is to encourage improvement by redistributing some cost savings back to the highest performers. One of the quality metrics that must be met for the perinatal episode is the percent of episodes with a follow-up visit within 60 days of birth.

Initiatives are still unfolding, with incentives for the perinatal episode of care in Ohio forthcoming, a second phase of Colorado’s initiative on the horizon, and plans in Alabama to establish regional care organizations in a Medicaid transformation model somewhat similar to Colorado that will include an incentive measure for prenatal and postpartum care. However, early results from Oregon and Colorado indicate improvement in support of planned births and healthy birth outcomes.

A new issue brief by the National Academy for State Health Policy (NASHP) in partnership with NICHQ explores experiences from Alabama, Colorado, Ohio and Oregon that demonstrate opportunities for cross-agency collaboration through payment and delivery reform to meet shared goals. States can consider aligning measures and incentives across Medicaid programs and Title V block grants, leveraging complementary data, and engaging state and local Title V or public health agency staff in Medicaid measure development and implementation to maximize resources and expertise.

For more information, download and read the new issue brief from NASHP/NICHQ: Opportunities for States to Improve Women’s Health and Birth Outcomes through Medicaid Incentives for Effective Contraceptive Use and Postpartum Care