Poor birth outcomes, such as pre-term birth, carry substantial human and financial costs and are generally influenced by women’s health and socioeconomic factors such as race, ethnicity, income, health care access, and education. According to the Institute of Medicine, the cost associated with pre-term birth in the U.S. is $26.2 billion each year, with Medicaid covering a higher percentage of pre-term births than private insurance. Since Medicaid plays a major role in financing delivery and other health care for pregnant women with risk factors for poor birth outcomes, state Medicaid agencies have implemented various strategies such as payment reform, performance incentives (provider and patient), and quality improvement initiatives to improve birth outcomes and reduce health care expenditures.
There are a number of coverage, benefit, and delivery system reforms that state Medicaid agencies are implementing to drive improvements in perinatal outcomes. One strategy is holding Medicaid providers or managed care organizations accountable for tracking or reporting their performance on quality measures that drive and support quality of care for women, specifically pregnant women. For example, the Ohio Perinatal Quality Collaborative (OPQC), a partnership between Ohio Medicaid, hospitals, and other stakeholders used various strategies, including revising Medicaid’s elective obstetric delivery reimbursement policy, to reduce Medicaid early elective deliveries with no medical indication from 10 percent to seven percent between 2006 to 2011.
From March to June 2017, NASHP conducted a 50 state scan to identify and confirm those state Medicaid agencies tracking and reporting key perinatal quality measures, as well as those implementing performance improvement projects (PIPs) and incentives to improve birth outcomes. We received responses from 36 states to confirm their activities, and we identified 47 states tracking and reporting on several of the Core Set of Maternity Measures for Medicaid and CHIP and Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP as well as state specific measures to monitor and assess women’s health services to improve perinatal outcomes. Nineteen states have implemented PIPs and performance incentives. Some examples of state activities include:
- California Medicaid is tracking substance use (including alcohol) among pregnant women. Although only a small portion were substance use dependent; it was disproportionately higher among Native American women on Medi-Cal.
- Three of Oregon’s Coordinated Care Organizations (Intercommunity Health Network, Pacific Source Community Solutions-Columbia George, and Pacific Source Community Solutions-Central Oregon) have implemented performance improvement projects focused on increasing oral health visits among pregnant members.
While quality measures, improvement projects, and incentives are great tools to support states efforts to improve perinatal outcomes, there is a potential opportunity for state Medicaid and Title V programs to collaborate and share data related to services and health outcome goals of mutual interest. Using different but complementary measures, Title V programs also tracks well-woman visits, low-risk cesarean delivery, early elective delivery, and early prenatal care in addition to other perinatal related metrics.
To learn more about state Medicaid agencies’ measures, improvement projects, and incentives, see the new chart and series of maps, and stay tuned for case studies that will take a closer look at efforts to promote improved women’s health and birth outcomes in several of the states!
This blog and related deliverables are joint publications of the National Academy for State Health Policy (NASHP) and the National Institute for Children’s Health Quality (NICHQ). This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) (under grant # UF3MC26524, Providing Support for the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, $2,918,909, no NGO sources).