title: Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care.
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.
authors.affiliation: 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.howell@mountsinai.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Howell
authors.affiliation: College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.|Center for Population Health, Lankenau Institute for Medical Research, Philadelphia, PA, USA.
authors.forename: Norma A
authors.initials: NA
authors.lastname: Padrón
authors.affiliation: Healthfirst, New York, NY, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Beane
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Stone
authors.affiliation: 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.
authors.forename: Virginia
authors.initials: V
authors.lastname: Walther
authors.affiliation: 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.
authors.forename: Amy
authors.initials: A
authors.lastname: Balbierz
authors.affiliation: Healthfirst, New York, NY, USA.
authors.forename: Rashi
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Center for Health Innovation, The New York Academy of Medicine, New York, NY, USA.|Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005102:Health Expenditures / Q000592:standards; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D008428:Maternal Mortality; D011181:Postnatal Care / Q000191:economics / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000517:prevention & control; D018566:Pregnancy, High-Risk; D011445:Prospective Payment System / Q000639:trends*; D014481:United States; D035862:Vulnerable Populations
keywords: Disparities; Maternal Health; Medicaid; Payment Reform