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

Maternal and Child Health Journal volume 21, pages 432–438 (2017)Cite this article

Abstract

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, 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 women identified as high-risk. 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 NCQA healthcare effectiveness data and information set guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, postpartum readmissions, 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.

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Funding

The funding was provided by Robert Wood Johnson Foundation (Grant No. 72257).

Author information

Affiliations

  1. Department of Population Health Science & Policy, Department of Obstetrics, Gynecology, and Reproductive Science, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA

    Elizabeth A. Howell

  2. College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA

    Norma A. Padrón

  3. Center for Population Health, Lankenau Institute for Medical Research, Philadelphia, PA, USA

    Norma A. Padrón

  4. Healthfirst, New York, NY, USA

    Susan J. Beane & Rashi Kumar

  5. Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA

    Joanne Stone

  6. Department of Preventive Medicine, Department of Pediatrics, Department of Obstetrics, Gynecology, and Reproductive Science, Associate Director of the Department of Social Work Services, Icahn School of Medicine at Mount Sinai, New York, USA

    Virginia Walther

  7. Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA

    Amy Balbierz

  8. Center for Health Innovation, The New York Academy of Medicine, New York, NY, USA

    José A. Pagán

  9. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    José A. Pagán

Authors
  1. Elizabeth A. Howell
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  2. Norma A. Padrón
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  3. Susan J. Beane
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  4. Joanne Stone
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  5. Virginia Walther
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  6. Amy Balbierz
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  7. Rashi Kumar
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  8. José A. Pagán
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Corresponding author

Correspondence to Elizabeth A. Howell.

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Howell, E.A., Padrón, N.A., Beane, S.J. et al. Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care. Matern Child Health J 21, 432–438 (2017). https://doi.org/10.1007/s10995-016-2221-8

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Keywords

  • Maternal Health
  • Payment Reform
  • Disparities
  • Medicaid