Howell, E. A., Balbierz, A., Beane, S., Kumar, R., Wang, T., Fei, K., Ahmed, Z., & Pagán, J. A. (2020). Timely Postpartum Visits for Low-Income Women: A Health System and Medicaid Payer Partnership. American journal of public health, 110(S2), S215–S218. https://doi.org/10.2105/AJPH.2020.305689
Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent Approach, Funding Support, Community Health Workers (CHWs),
Intervention Description: This multi-component intervention included patient education about health conditions (hypertension, gestational diabetes, and depression), important health behaviors (nutrition and exercise), and common postpartum symptoms; taught self-management skills; enhanced social support; and connected patients with community resources and health care services, including transportation needs. The intervention also addressed specific psychosocial needs of enrollees. A payment reform component included a cost-sharing arrangement between the health care system and the Medicaid payer to cover costs related to employing a social worker and community health worker, and financial incentives for completed postpartum visits.
Intervention Results: Compared with women in the control group, program participants had higher rates of postpartum visits in the HEDIS-defined time period (66.9% vs 56.0%; P < .001) and higher rates of all postpartum outpatient or gynecologic care up to 90 days after delivery (90.2% vs 83.4%; P= .002). Similarly, program participants were more likely to be enrolled with the Medicaid plan than mothers in the matched comparison group at six months after delivery (79.1% [400/506] vs 73.3% [742/1012]; P= .015) and at one year after delivery (71.0% [359/506] vs 66.3% [671/1012]; P= .067), although this was not statistically significant at one year after delivery.
Conclusion: This novel partnership between a health care system and a Medicaid payer increased postpartum visits among high-risk, low-income mothers. The follow-up rate was higher for visits that occurred within 90 days after delivery, a period consistent with current recommendations for postpartum care from the American College of Obstetricians and Gynecologists. This is one of few initiatives that have integrated health care systems, payers, physicians, and social workers to address access to care and social determinants of health for underserved women.
Study Design: Propensity scoring of Medicaid claims data from 2014 to 2017 was used to compare timely postpartum visits for mothers enrolled in the intervention program versus a similar group of mothers enrolled in the same Medicaid plan who gave birth in 2015 and 2016.
Setting: Mount Sinai Hospital, a large tertiary hospital in New York City
Population of Focus: Women insured by Healthfirst who delivered between April 2015 and October 16 who spoke Spanish or English and had at least 1 of the following: gestational diabetes, hypertension, positive screen for depression, late registration for prenatal care (> 20 weeks), or residence in neighborhoods considered at high risk for diabetes or hypertension.
Sample Size: 506
Age Range: ≥18
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