23 Mar Solutions to Improve Maternal Health RFI Response
The Health Care Transformation Task Force (HCTTF or Task Force) thanks the Senate Finance Committee for seeking information from health care stakeholders on specific, evidence-based solutions to address poor maternal health outcomes and improve maternal health in the U.S.
The Task Force believes that applying a value-based paradigm to maternity care is one critical lever to positively impact maternal health outcomes. Last year, HCTTF issued a report: Expanding Access to Outcomes-Driven Maternity Care through Value Based Payment, which describes the most common value-based payment strategies for maternity care and evidence of their effectiveness to reduce costs and improve quality, as well as the barriers to more widespread adoption. The Task Force also wrote to the Centers for Medicare and Medicaid Services (CMS) urging the Center for Medicare and Medicaid Innovation (CMMI) to test an alternative payment model (APM) for maternity care. The Task Force also recently endorsed the Black Maternal Health Momnibus Act of 2020 (H.R. 6142/ S. 3424), and specifically the IMPACT to Save Moms Act (H.R. 6137), which would advance this objective.
Task Force Response Summary
HCTTF believes CMS should test a multi-payer maternity care model in order to advance industry understanding and adoption of the most effective models for maternity care payment. The Medicaid program provides the greatest opportunity to test and encourage adoption of alternatives to fee-for-service for maternity payment, which pays for about half of all births in the country, and we believe a partnership with commercial payers will amplify the model’s impact.
CMS should expedite the approval process for Medicaid state plan amendments and waivers to implement maternity care APMs that hold states and providers accountable for improved outcomes, and provide guidance about how to do so through State Medicaid Director letters. A maternal health APM should ensure clinical delivery that is aligned with evidence-based practices. Key clinical objectives of the APM could include increased prenatal care utilization, reduction of the rate of unnecessary Cesarean section deliveries, and improvement in rate of babies born at a health birth weight. Alternative payment models should also address improving screening and treatments for perinatal mood and anxiety disorders (PMADs).
It is essential that a maternity APM reduces racial disparities in morbidity and mortality. Ensuring that the model evaluation stratifies outcomes by race, ethnicity, and socioeconomic indicators, as specified in the IMPACT to Save Moms Act, will be essential to measuring progress on this goal.