The Centers for Medicare & Medicaid Services (CMS) has announced a new payment model designed to focus on improving maternal health care for people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
The Transforming Maternal Health (TMaH) model will support participating State Medicaid Agencies (SMAs) in developing a comprehensive approach to pregnancy, birth, and postpartum care that addresses the social, physical, and mental health needs experienced during the pregnancy. The goal of the model is to reduce disparities in access and treatment. The model aims to improve the outcomes and experiences of mothers and their newborns, while reducing overall program expenses.
The model is expected to operate for 10 years.
A CMS notice described the scope of the problem: “Despite spending more per capita on maternal health care than any other country, the United States has disproportionately high rates of adverse pregnancy outcomes compared to other high-income nations. The TMaH model provides SMAs with specific support in the form of funding and technical assistance. The goal of this support is to improve maternal health care and birth outcomes while reducing associated health disparities. “This support also allows states to develop an alternative value-based payment model for maternity care services that will improve quality and health outcomes and promote the long-term sustainability of services.”
CMS outlined three main pillars of TMaH initiatives:
• Access to care, infrastructure and workforce capacity: TMaH will support relationship building and education to help participating states address barriers that limit access to valuable resources, such as midwives, doulas, and community perinatal health workers (CHWs). Greater access to these resources can have numerous benefits, including reducing the number of cesarean sections in low-risk pregnancies, reduced labor time, reduced use of pain medications during childbirth, and lower rates of postpartum anxiety and depression. Participating SMAs will be able to promote person-specific care that is culturally sensitive and rooted in active listening and trust-building, with the goal of further empowering mothers to manage their birth experience.
• Improvement of quality and safety: Participating SMAs will implement quality initiatives and protocols with the goal of making childbirth safer and improving the overall experience of mother and baby. These evidence-based interventions are called “patient safety bundles.” When implemented together and consistently, these protocols have been shown to improve health outcomes in several clinical areas, including hypertension during pregnancy, heart conditions, and care of pregnant and postpartum people living with substance use disorders. substances. Participating SMAs will also work with their hospitals and health systems to achieve the CMS “Makes Birth Easier” designation, which is the first federal quality designation with a focus on maternal health for hospitals and health systems.
• Provision of comprehensive care to the person: Pregnancy and childbirth are deeply personal experiences and each person’s journey is unique. Under the TMaH model, participating SMAs will strive to ensure that each mother receives personalized care to meet her specific needs by supporting the development of a unique birth plan. Individuals will be assessed during their initial prenatal visit to determine what additional supports, if any, they may need for health-related social needs, mental health, or substance use disorder. Based on her physical, social and mental health needs, a care plan will be developed in collaboration with the mother. When appropriate, remote monitoring for conditions such as hypertension and diabetes can be offered to reduce the burden of traveling to and from a doctor’s office. People may also be connected to community organizations or a community health worker based on any health-related social needs they may have.
CMS will publish a Notice of Funding Opportunity (NOFO) to state Medicaid agencies in spring 2024. Applications will be due in summer 2024.
