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Resources on Strategies to Improve Postpartum Care Among Medicaid and CHIP Populations

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Resources on Strategies to Improve Postpartum Care Among Medicaid and CHIP Populations TECHNICAL ASSISTANCE RESOURCE February 2015 Resources on Strategies to Improve Postpartum Care Among Medicaid and CHIP Populations Introduction Using Quality Improvement Strategies in Postpartum Care To support states participating in the Postpartum Care Action Learning Series, the Centers for Medicare & Medicaid Services (CMS) developed a resource for The Centers for Medicaid and CHIP Services (CMCS) has established the Maternal and Infant Health Initiative strategies that may be effective in increasing the to improve the postpartum visit rate by 10 percentage postpartum care visit rate and improving the content of points in at least 20 states over 3 years (among other the visit among states’ Medicaid and CHIP populations. goals). The Improving Postpartum Care Action Learning The information presented in this resource reflects Series is one of the Initiative’s projects, in which 11 states materials gathered from the peer-reviewed literature; are using quality improvement (QI) strategies to identify reports from state Medicaid programs and Medicaid changes and test them in a Plan, Do, Study, Act cycle. By managed care organizations (MCOs); and materials for employing the QI process in a variety of settings, the series providers and patients produced by health plans, MCOs, will increase knowledge about how to improve the and other organizations. postpartum care visit rate and also inform state policies to support CMCS in achieving its goals. While not exhaustive, the resource includes a range of evidence-based strategies, best practices, and advice to providers. The materials cover approaches to increasing the number of women who make and keep a postpartum • Table 2—Drivers and change ideas to increase visit and to improving the measurement process in clinical postpartum visits for Medicaid and CHIP settings. Many of the projects or programs described in populations. This table summarizes the changes the guide include multiple interventions. The guide also described in Table 1, organized by their relationship to presents information on interventions that have been four primary drivers of postpartum care quality: tested at the MCO, provider, and member level, and • Engage women in their care across the prenatal, postpartum, and interconception • Redesign the delivery system periods. • Identify community supports This resource contains three components: • Align Medicaid and CHIP and MCO policies • Table 1—Strategies to improve the postpartum • References—This component provides references care visit rate and the content of care. This table related to the changes described in Table 2 and some describes approaches to improving the postpartum care additional resources on postpartum care. visit, organized by the type or level of intervention. The table contains a detailed summary of the changes (or interventions), the relevant sites and populations, For More Information and outcomes if they are available. Please email [email protected] if you have questions or comments about the information in this resource. ■ This technical assistance resource is a product of the Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program, sponsored by the Centers for Medicare & Medicaid Services. The program team is led by Mathematica Policy Research, in collaboration with the National Committee for Quality Assurance and Center for Health Care Strategies. 1 Table 1. Strategies to improve the postpartum care visit rate and the content of care Change Timing of Study strategy intervention site(s) Population Description of intervention Outcomes Source Peer supports Establish prenatal Prenatal Hospital- Latinas, the Women were randomized to usual • 73 percent with Marsiglia, F.F., M. partners (bilingual, visits starting, based urban majority of whom care or to receive intervention of prenatal partners Bermudez-Parsai, bicultural cultural on average, clinic in were low-income, meetings with prenatal partners: had PPC visit and D. Coonrod. brokers) at 5 months Phoenix, first-generation • Bilingual and bicultural social work versus 51 “Familias Sanas: An • Showed (but not after Arizona immigrants; 81 students were trained as prenatal percent in control Intervention pregnant 34 weeks) percent Mexican partners (study emphasizes lay group Designed to Increase women how to heritage: workers can be trained for this • 79 percent who Rates of Postpartum navigate the • Inclusion criteria: role and prenatal partners did not met with prenatal Visits among health system, age 18 or older, perform counseling) partner 5 to 20 Latinas.” Journal of Health Care for the encouraged Latina, no prior • Patients met with prenatal times had PPC Poor and self-advocacy PNC for current partners in waiting room before visit versus 62 Underserved, vol. for women and pregnancy, less seeing provider for first visit and percent who met 21, no. 3, suppl. their children, than 34 weeks then after each subsequent with prenatal 2010, pp. 119–131. and helped pregnant prenatal visit partner 1 to 4 times improve • Intervention • Prenatal partners provided http://www.ncbi.nlm. communication (n = 221); education on PNC, discussed nih.gov/pmc/articles/ with providers usual care patient concerns, encouraged PMC2944022/ • Helped women (n = 219) women to advocate for their develop a plan health in visits with provider and for their PNC communicate concerns and postpartum • Prenatal partners followed up with visits by women who missed PNC visit and identifying identified barriers and solutions to barriers to enable them to attend visits accessing • health care and 4-month intervention possible • Patient-driven conversations solutions to challenges Establish doula Pregnancy, Seven Pregnant women • Voluntary participation Women paired Greenberg, L. program delivery, and hospitals in Medicaid MCO • Doulas assisted with scheduling with doulas had a “Treatment • Community postpartum and birth from Allegheny and keeping prenatal, postpartum, 10 percent higher Adherence Best women trained in-hospital centers county referred to newborn appointments, answered PPC visit rate than Practices as certified period affiliated the doula program questions, provided general women without Compendium.” doulas with support and education, reinforced doulas Washington, DC: University of Medicaid Health • Support high- provider messages, assisted Pittsburgh Plans of America, risk, primarily women in creating a birth plan, Medical Center for Best African linked women to MCO’s case Center Practices, 2012, p. American managers for care coordination 26. women and support http://www.mhpa.org/ _upload/adherencec ompendiumweb2.pdf 2 Change Timing of Study strategy intervention site(s) Population Description of intervention Outcomes Source Postpartum care patient education and outreach Implement Prenatal and CareNet Medicaid • Educational mailings to members • Increase in the Greenberg, L. comprehensive postpartum (Virginia population • Communications to providers Medicaid MCOs “Treatment set of periods Medicaid (remind providers about maternity PPC rate over Adherence Best interventions MCO) incentive program and include three years, from Practices targeted to information on HEDIS® measures 62.7 to 70.6 Compendium.” women and and rates) percent Washington, DC: providers • Transportation services (when • Moved from 10th Medicaid Health eligible) HEDIS percentile Plans of America, Center for Best • Home visits in 2007 to 75th percentile in Practices, 2012, p. • Member incentive for making and 2011 18. keeping the postpartum http://www.mhpa.org/ appointment _upload/adherencec • High-risk OB case management ompendiumweb2.pdf • Postpartum phone calls • Postpartum depression information and assessments • Wrap-around mental health services • Provide PNC Prenatal AMERI- Medicaid • Women received PNC and PPC 100 percent of America’s Health and PPC through GROUP, population information packets and a list of participants Insurance Plans. information postpartum Taking Care community resources such as attended their “Innovations in packets period of Baby and childbirth education classes PPC visits Medicaid Managed • Use OB care Me • OB care managers surveyed compared with 49 Care: Health Plan managers and (Medicaid pregnant women on risk factors percent of Programs to Improve individual care MCO) and created personalized care nonparticipants the Health and Well- plans for high- plans Being of Medicaid risk women • Care managers maintained Beneficiaries.” contact at least once per month to Washington, DC: ensure women received PNC and America’s Health PPC Insurance Plans, Center for Policy and • Women received gift incentives Research, March (such as baby care items) to 2005, p. 40. encourage them to keep appointments https://www.ahip.org/ Innovations-in- Medicaid-Managed- Care-Report/ 3 Change Timing of Study strategy intervention site(s) Population Description of intervention Outcomes Source Comprehensive case management and care management • Use OB care Prenatal Kentucky Medicaid • Plan representatives called PPC visit rate America’s Health managers for through Passport population members and encouraged PNC, increased from 58 Insurance Plans. high-risk women postpartum Health Plan, assessed risk factors, and percent to 75 “Innovations in • Provide period Mommy and suggested community resources percent over four Medicaid Managed information by Me such as WIC years Care: Health Plan telephone and (Medicaid • Nurse care managers sent Programs to Improve mail MCO) women a guide designed for low- the
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