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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 is implementing a program to increase postpartum visits and improve health outcomes among Medicaid-insured women.

Partners:

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% are Hispanic, 24% are Black, and 6% identify as either White, Asian, or Other race/ethnicity. At baseline, fifteen percent have depressive symptoms, 21 percent have hypertension, 10 percent have gestational diabetes, and 6 percent register late (at 20 weeks or later) for prenatal care. Almost half (47%) of women are foreign born, 29 percent are primarily Spanish-speaking, and over 50 percent (55%) have less than or equal to a high school education.

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Patient participants

The study focuses on high-risk postpartum women with diabetes, hypertension or depressive symptoms, as well as those who register 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 have all given birth at Mount Sinai Hospital and are 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 receive 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 coordinate care and follow up with patients through phone calls after discharge.

Provider education

Physicians and clinic staff receive 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 receive a small financial incentive and a roundtrip Metrocard for attending their postpartum visit.

Patient assessment

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

Monitoring of associated measures of health and clinical care

These include 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, is 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 is currently focused on discovering how healthcare payment and delivery systems can be redesigned to reduce and eliminate health care disparities. Its current work includes three pilot projects involving health systems and payers partnering to improve health equity.

More information about the Finding Answers payment and delivery system reform initiative is available here.