State Strategies for Improving Maternal and Infant Care

Low birth weight and preterm birth carry substantial human and financial costs; they also are associated with health problems that can have long-lasting effects. Renewed state and national commitment to improving birth outcomes and the quality of maternal and infant care are evident in states across the country as well in federal initiatives such as the Health Resources and Services Administration (HRSA)’s Collaborative Improvement & Innovation Network (CoIIN) to Reduce Infant Mortality and Healthy Start program, as well as the Centers for Medicare and Medicaid Services (CMS)’ Strong Start for Mothers and Newborns and Maternal and Infant Health Initiative.  These federal initiatives engage state policy makers, providers, and other stakeholders.

States also are pursuing improvement in maternal and infant care through their own targeted initiatives as well as part of broader efforts to achieve the Triple Aim of better experience of care, better population health and lower costs.  A focus on improving maternal and infant health while reducing the high costs associated with adverse pregnancy outcomes is important for moms and babies and for improving outcomes and reducing costs over their lifetimes.

Over the past year, NASHP, in collaboration with HRSA, has explored state and federally qualified health center (FQHC) policies that support early entry into prenatal care (a prenatal visit within the first trimester of pregnancy), within the context of a patient-centered medical home (PCMH) framework. Early prenatal care entry is associated with positive birth outcomes. A new series of NASHP fact sheets shares overall findings and highlights California’s Comprehensive Perinatal Services Program (CPSP) and Washington State’s First Steps Program; both offer eligible women enhanced services that support coordinated, comprehensive and accessible care and are leveraged by FQHCs to ensure early access to prenatal care.

Financing strategies such as these are important levers for improving infant and maternity care. Another strategy is reducing or eliminating Medicaid payment for early deliveries or Cesarean sections that aren’t medically necessary. Washington State along with New York, South Carolina (as part of the South Carolina Birth Outcomes Initiative), and Texas (as part of the Healthy Babies Texas initiative) are examples of states that have implemented this type of policy.

Other states have implemented financial incentives for improving prenatal and perinatal care as part of broad efforts to transform how health care is paid for and delivered across an entire Medicaid program.

  • Through its Health Care Payment Improvement Initiative, Arkansas Medicaid strives to achieve the Triple Aim by creating and ensuring a coordinated experience of care within a system that rewards high-quality, high-value care. Providers receive care coordination fees for serving as a PCMH.  Certain providers, including obstetricians and gynecologists, also have accountability for health care costs and outcomes for specific episodes of care. One of the episodes is perinatal and includes all pregnancy-related care. To share in any incentives or savings associated with the perinatal episode of care, a provider must track quality measures such as C-section rate and meet performance targets on additional measures. If the provider meets those targets and delivers care at a low or reasonable cost relative to others for the same episode, s/he is eligible to share in the savings.
  • Oregon has established Coordinated Care Organizations (CCOs) to ensure integrated and coordinated health care for Medicaid enrollees as part of the Triple Aim. CCOs are responsible for delivering high-quality care and tracking and reporting on their performance. Funds from a quality pool are awarded to CCOs based on their performance on incentive measures. The CCO incentive measures cover a range of areas including improvement in perinatal and maternity care. One incentive measure is timeliness of prenatal care or the percent of women with a prenatal visit in their first trimester.

Strategies to improve maternal and infant care, including through improved early entry into prenatal care, are underway in many states and increasingly part of broad state efforts to achieve the Triple Aim. The strategies are an important part of realizing better care and better health for moms and babies and lower costs for states.  Learn how state strategies are particularly important for ensuring equity in birth outcomes and coverage and care for pregnant women at NASHP’s 27th Annual State Health Policy Conference.

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