Design Payment Transformation

The Icahn School of Medicine at Mount Sinai Redesigning Payment and Care Delivery to Improve Postpartum Care and Health for Low-income Mothers

Challenge

Postpartum follow-up care offers a chance to influence maternal and child health for vulnerable populations. Yet staff and researchers at Mount Sinai Hospital found that a sample of Medicaid-covered women—most of them Hispanic or Black—received timely postpartum care only 58% of the time compared with national figures that suggest a rate of 80% to 90% for low-risk white, commercially insured women. The rate was even lower among mothers on Medicaid with hypertension (46%) or diabetes (50%). Mount Sinai worked to implement a program to increase postpartum visits and improve health outcomes among Medicaid-insured women.

Partners:

Icahn School of Medicine at Mount Sinai; New York Academy of Medicine (Investigators)
Mount Sinai Hospital (Provider)
Healthfirst Inc. (Payer/Medicaid managed care insurer)

Setting

Mount Sinai Health System is one of the largest providers in the United States, and Mount Sinai Hospital oversees more than 7,000 births annually. About 680 of these deliveries are to women on a Healthfirst Medicaid Managed Care plan.

Of the women enrolled in the study, 70% were Hispanic, 24% were Black, and 6% identified as either White, Asian, or Other race/ethnicity. At baseline, fifteen percent had depressive symptoms, 21 percent had hypertension, 10 percent had gestational diabetes, and 6 percent registered late (at 20 weeks or later) for prenatal care. Almost half (47%) of women were foreign born, 29 percent were primarily Spanish-speaking, and more than 50 percent (55%) had less than or equal to a high school education.

Incentivizing Postpartum Care: How it Works

Icahn School of Medicine at Mount Sinai

The study worked to improve the quality and frequency of postpartum care for low-income Mt. Sinai patients with or at high risk for diabetes, depression or hypertension, through a combination of physician and patient incentives. In the intervention model, ob/gyn physicians received a small bonus payment from Healthfirst (via Mt. Sinai) for every Healthfirst enrollee who received a timely postpartum visit; they also would get continuing medical education on quality care for chronic diseases. Clinical staff, including a care coordinator and a social worker, helped connect women to care, followed up with them, screened for depression and other issues, and educated patients on the importance of postpartum visits. There was a cost-sharing arrangement between Mount Sinai and Healthfirst to cover staff and provide clinician education and incentives.

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Patient participants

The study focused on high-risk postpartum women with diabetes, hypertension or depressive symptoms, as well as those who registered late for prenatal care or reside in NYC neighborhoods with high rates for diabetes and/or hypertension (according to the NYC Department of Health and Mental Hygiene). They all had given birth at Mount Sinai Hospital and were insured by a Healthfirst Medicaid Managed Care plan.

Intervention team

Mount Sinai Hospital postpartum care team members, including ob/gyn physicians, psychiatrists, a social worker and a bilingual clinical care coordinator paid for by Healthfirst and Mount Sinai.

Payment incentive

Physicians received a small payment bonus at the end of the year for all Healthfirst-enrolled women in their care who had a postpartum visit between 21 and 56 days after delivery.

Tools for success

Care management and coordination

A social worker and community health worker coordinated care and follow up with patients through phone calls after discharge.

Provider education

Physicians and clinic staff received information through grand rounds, online education, communications through Healthfirst’s Spectrum of Health program (with information on preventive services and health conditions), and outreach.

Patient incentives

Patients received a small financial incentive and a roundtrip Metrocard for attending their postpartum visit.

Patient assessment

Patients were assessed for full medical history, psychosocial drivers of hospital readmission, and social connectedness.

Monitoring of associated measures of health and clinical care

The associated measures of health and clinical care included: postpartum visits; screening for blood pressure; depression and glucose levels (for gestational diabetes); and maternal emergency department visits.

Finding Answers: Solving Disparities Through Payment and Delivery System Reform was a national program funded by the Robert Wood Johnson Foundation with technical assistance and direction provided by the University of Chicago. Finding Answers was created to discover and disseminate practical ways to achieve health equity and was focused on discovering how healthcare payment and delivery systems can be redesigned to reduce and eliminate health care disparities. Its work included three pilot projects involving health systems and payers partnering to improve health equity. To read more about Finding Answers, please click here.