Giving birth in the United States is dangerous, and even more so if you are Black or Indigenous, live in a rural area, or have a low income. Maternal deaths continue to rise, even though the vast majority are preventable. The rate of people experiencing severe maternal morbidity is climbing, and perinatal anxiety and depression are widespread and go largely untreated. Meanwhile, our cesarean birth rate remains stubbornly high despite professional guidelines that aim to curtail unneeded cesareans. More than one-third of US counties have been designated as maternity care deserts.
This intractable maternal health crisis threatens our shared future as a country. Research shows that what happens from pregnancy through the postpartum and infant periods can have long-term, even lifelong, health effects for birthing people and their children.
One leading strategy for confronting this crisis is to advance payment and delivery reforms with the specific aim of improving maternal-newborn outcomes and increasing equity. In particular, two care delivery and payment models—maternity care episode payment and maternity care home programs—have great potential for driving transformational change. And yet, we have found that reality falls far short of the promise of such payment and delivery transformation. Few payers are offering these programs, and provider uptake—largely voluntary—is limited. Moreover, data on whether models impact maternal-newborn outcomes and reduce racial and ethnic inequities are not—at least publicly—available.
These insights and our recommendations below are based on a comprehensive landscape study (with a technical supplement) published today by the National Partnership for Women & Families. The study examined existing and anticipated alternative payment model (APM) programs and is based on dozens of interviews with health plan and employer purchaser program managers, birth justice leaders, and payment reform thought leaders.
We also present our recommendations here in the context of the recent announcement from the Centers for Medicare and Medicaid Services (CMS) introducing its new APM, Transforming Maternal Health (TMaH). TMaH will award up to 15 state Medicaid agencies up to $17 million each, along with in-kind services, to plan and implement equity-focused maternal health APMs over a 10-year period. We are hopeful that the TMaH program will generate much-needed positive transformation to improve maternal health.
Whether as part of the new TMaH program or the broader maternity APM landscape, moving the needle on better outcomes for childbearing families at scale will require health care decision makers to take five actions. To learn about the priority of advancing equity, improving quality, bolstering designs, supporting culture change, and leveraging Medicaid, read the rest of this blog at Health Affairs Forefront.
