Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care

Purpose: This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women.

Description: A large health care system in a large metropolitan area, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for high-risk women. The program includes a social work/care management component and a payment system redesign with a cost-sharing arrangement between the health system and the Medicaid managed care plan to cover the cost of staff, clinician education, performance feedback, and clinic/clinician financial incentives. The goal is to enroll 510 high-risk postpartum mothers.

Assessment: The primary outcome of interest is a timely postpartum visit in accordance with the appropriate NCQA HEDIS guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, rehospitalizations, depression screens, and health care costs.   

Conclusion: Our evidence-based program focuses on an important area of maternal health, targets racial/ethnic disparities in postpartum care, utilizes an innovative payment reform strategy, and brings together insurers, researchers, clinicians, and policy experts to work together to foster health and wellness for postpartum women and reduce disparities.