Maternal and Child Health Journal

, Volume 21, Issue 3, pp 432–438 | Cite as

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

  • Elizabeth A. HowellEmail author
  • Norma A. Padrón
  • Susan J. Beane
  • Joanne Stone
  • Virginia Walther
  • Amy Balbierz
  • Rashi Kumar
  • José A. Pagán
From the Field


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.


Maternal Health Payment Reform Disparities Medicaid 



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


  1. Ahmed, R., Dunford, J., Mehran, R., Robson, S., & Kunadian, V. (2014). Pre-eclampsia and future cardiovascular risk among women: A review. Journal of the American College of Cardiology,63 (18),1815–1822.Google Scholar
  2. Bentley-Lewis, R., Powe, C., Ankers, E., Wenger, J., Ecker, J., & Thadhani, R. (2014). Effect of race/ethnicity on hypertension risk subsequent to gestational diabetes mellitus. The American Journal of Cardiology, 113(8), 1364–1370.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Bryant, A. S., Seely, E. W., Cohen, A., & Lieberman, E. (2005). Patterns of pregnancy-related hypertension in black and white women. Hypertension in pregnancy: official journal of the International Society for the Study of Hypertension in Pregnancy, 24(3), 281–290.CrossRefGoogle Scholar
  4. Cabacungan, E. T., Ngui, E. M., & McGinley, E. L. (2011). Racial/ethnic disparities in maternal morbidities: A statewide study of labor and delivery hospitalizations in wisconsin. Maternal and Child Health Journal, 16(7),1455–1467.CrossRefGoogle Scholar
  5. Ferrara, A., Peng, T., & Kim, C. (2009). Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: A report from the translating research into action for diabetes (TRIAD) study. Diabetes Care, 32(2), 269–274.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Guendelman, S., Thornton, D., Gould, J., & Hosang, N. (2006). Obstetric complications during labor and delivery: assessing ethnic differences in California. Womens Health Issues, 16(4), 189–197.CrossRefPubMedGoogle Scholar
  7. Howell, E. A., Balbierz, A., Wang, J., Parides, M., Zlotnick, C., & Leventhal, H. (2012). Reducing postpartum depressive symptoms among black and Latina mothers: a randomized controlled trial. Obstetrics and Gynecology, 119(5), 942–949.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Howell, E. A., Bodnar-Deren, S., Balbierz, A., Parides, M., & Bickell, N. (2014). An intervention to extend breastfeeding among black and Latina mothers after delivery. American Journal of Obstetrics and Gynecology, 239(3), e231–e235.Google Scholar
  9. Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6), 1442–1450.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619–625.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Kozhimannil, K. B., Pereira, M. A., Harlow, B. L. (2009). Association between diabetes and perinatal depression among low-income mothers. JAMA, 301(8),842–847.CrossRefPubMedGoogle Scholar
  12. Mount Sinai Faculty Practice (2014). Facts about coordinated care at Mount Sinai. Accessed 15 April 2014.
  13. National Research Council (US) and Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy Development of Children (2009). In M. J. England & L. J. Sim (Ed.), Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention. Washington (DC): National Academies Press (US). Available from:
  14. NCQA. 2014 Accreditation benchmarks and thresholds—mid-year update. 2014.
  15. Pfuntner, A., Wier, L. M., Stocks, C. (2011). Most frequent conditions in U.S. hospitals, Statistical Brief #162. Feb 2006.Google Scholar
  16. Savitz, D. A., Danilack, V. A., Engel, S. M., Elston, B., & Lipkind, H. S. (2014). Descriptive epidemiology of chronic hypertension, gestational hypertension, and preeclampsia in new york state, 1995–2004. Maternal and Child Health Journal, 18(4), 829–838.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Siddiqui, R., Bell, T., Sangi-Haghpeykar, H., Minard, C., & Levison, J. (2014). Predictive factors for loss to postpartum follow-up among low income HIV-infected women in Texas. AIDS Patient Care and STDs, 28(5), 248–253.CrossRefPubMedGoogle Scholar
  18. Stasenko, M., Liddell, J., Cheng, Y. W., Sparks, T. N., Killion, M., & Caughey, A. B. (2011). Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 522(6), e521–e526.Google Scholar
  19. Thorpe LE, Berger D, Ellis JA, et al. (2005). Trends and racial/ethnic disparities in gestational diabetes among pregnant women in New York city, 1990–2001. American Journal of Public Health, 95(9), 1536–1539.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Elizabeth A. Howell
    • 1
    Email author
  • Norma A. Padrón
    • 2
    • 3
  • Susan J. Beane
    • 4
  • Joanne Stone
    • 5
  • Virginia Walther
    • 6
  • Amy Balbierz
    • 7
  • Rashi Kumar
    • 4
  • José A. Pagán
    • 8
    • 9
  1. 1.Department of Population Health Science & Policy, Department of Obstetrics, Gynecology, and Reproductive Science, Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.College of Population HealthThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Center for Population HealthLankenau Institute for Medical ResearchPhiladelphiaUSA
  4. 4.HealthfirstNew YorkUSA
  5. 5.Department of Obstetrics, Gynecology, and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkUSA
  6. 6.Department of Preventive Medicine, Department of Pediatrics, Department of Obstetrics, Gynecology, and Reproductive Science, Associate Director of the Department of Social Work ServicesIcahn School of Medicine at Mount SinaiNew YorkUSA
  7. 7.Department of Population Health Science & PolicyIcahn School of Medicine at Mount SinaiNew YorkUSA
  8. 8.Center for Health InnovationThe New York Academy of MedicineNew YorkUSA
  9. 9.Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkUSA

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