Despite the United States’ position as a global leader in healthcare spending per capita for maternal care, the nation unfortunately experiences disproportionately elevated rates of adverse pregnancy outcomes when compared to other high-income countries. Recognizing this critical issue, the TMaH Model offers targeted and substantial support to State Medicaid Agencies (SMAs) through dedicated funding and comprehensive technical assistance. This support mechanism is strategically designed to foster improvements in maternal health care programs and birth outcomes, with a strong emphasis on mitigating associated health disparities. Furthermore, this model empowers states to pioneer value-based alternative payment models specifically for maternity care services. These innovative payment structures are intended to drive improvements in care quality and overall health outcomes, while also ensuring the long-term sustainability of essential maternal health services.
The TMaH initiative is structured around three fundamental pillars, each crucial to the success of the maternal health care program:
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Access to Care, Infrastructure, and Workforce Capacity: Acknowledging that access is paramount in any effective maternal health care program, TMaH prioritizes building strong relationships and facilitating educational opportunities for participating states. These efforts are aimed at dismantling barriers that currently restrict access to vital resources. These resources include crucial maternal health providers such as midwives and doulas, as well as perinatal Community Health Workers (CHWs). Expanding access to these diverse professionals offers numerous potential benefits. These benefits range from a reduction in cesarean sections (c-sections) for pregnancies deemed low-risk, to shortened labor durations, decreased reliance on pain medication during childbirth, and lower incidences of postpartum anxiety and depression. Participating SMAs will be empowered to promote maternal health care that is deeply person-specific, culturally sensitive, and firmly rooted in active listening and the cultivation of trust. The overarching goal is to empower mothers to take a more active and informed role in managing their birth experiences.
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Quality Improvement and Safety: Ensuring the highest standards of care is central to this maternal health care program. Participating SMAs will be tasked with implementing robust quality improvement initiatives and safety protocols. The primary objective is to enhance the safety of childbirth and improve the overall experience for both mothers and their newborns. These evidence-informed interventions are structured as “patient safety bundles.” When consistently and comprehensively implemented, these protocols have demonstrated significant improvements in health outcomes across various critical clinical areas. These areas include managing hypertension during pregnancy, addressing cardiac conditions, and providing specialized care for pregnant and postpartum individuals grappling with substance use disorders. Participating SMAs will also collaborate closely with their hospitals and health systems to achieve the CMS “Birthing-Friendly” designation. This designation is a landmark achievement, representing the first federal quality benchmark focused specifically on maternal health within hospitals and health systems.
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Whole-Person Care Delivery: Recognizing the profoundly personal nature of pregnancy and childbirth, the TMaH Model emphasizes that effective maternal health care programs must be individualized. Each person’s journey is unique, and the TMaH Model is committed to ensuring that every mother receives care meticulously tailored to meet her specific needs. This personalized approach begins with supporting the development of a unique birth plan for each individual. During the initial prenatal visit, individuals will undergo comprehensive screening to identify any additional supports they may require. This assessment covers health-related social needs, mental health concerns, or substance use disorder. Based on a holistic understanding of their physical, social, and mental health needs, a customized care plan will be developed in close collaboration with the mother. Where clinically appropriate, remote monitoring technologies may be offered for conditions such as hypertension and diabetes. This aims to alleviate the burden of frequent travel to and from healthcare facilities. Furthermore, individuals may be connected with community organizations or a community health worker to address any identified health-related social needs, ensuring a comprehensive network of support.
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Highlights of the Maternal Health Care Program |
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| – Women enrolled in Medicaid, particularly those within underserved communities and/or rural locations, frequently encounter significant disparities in maternal health care access and experience poorer health outcomes for both themselves and their newborns. – TMaH is strategically designed to collaborate with participating states to bridge critical gaps in maternal health care. This will be achieved through targeted activities such as bolstering access to midwives and doulas, enhancing prenatal care protocols for chronic conditions like diabetes and hypertension, and actively working to reduce complicated procedures like c-sections for mothers with low-risk pregnancies. – This maternal health care program promotes a more positive and supportive care environment, empowering mothers to actively participate in the development of their birth plans. This ensures that mothers feel heard and that their physical, mental health, and health-related social needs are comprehensively addressed. – A cornerstone of the TMaH model is the requirement that all participating State Medicaid Agencies develop and rigorously implement a health equity plan. These plans are specifically designed to address and mitigate disparities among underserved populations, ensuring equitable access to quality maternal health care. Participating State Medicaid Agencies are also committed to supporting the extension of Medicaid and CHIP postpartum coverage to a full 12 months. This extension is crucial for promoting ongoing preventive care, ensuring overall maternal health, and ultimately contributing to a reduction in long-term healthcare costs. |
Model Design of the Maternal Health Care Program
Model Phases: The TMaH maternal health care program is structured with a phased approach. It begins with a 3-year Pre-implementation Period. During this critical phase, states receive focused technical assistance to develop and strengthen each element of the model and to successfully achieve essential pre-implementation milestones. This is followed by a 7-year Implementation Period, dedicated to the full execution and operationalization of the model.
Model Participation: TMaH is designed as a state-based model, with State Medicaid Agencies serving as the primary award recipients and drivers of the maternal health care program. However, the model recognizes that collaborative partnerships are essential for success. Key collaborators include Managed Care Organizations (MCOs), Perinatal Quality Collaboratives, hospitals, birth centers, health centers and rural health clinics, maternity care providers across various disciplines, and community-based organizations deeply embedded within the communities they serve.
A defining feature of TMaH’s approach to fostering person-centered maternal health care is the deliberate expansion of access to a diverse spectrum of maternity care providers. This includes not only traditional medical professionals but also valued providers like midwives and doulas, who offer crucial non-clinical support, advocacy, and guidance throughout the pregnancy and postpartum journey. CMS will award Cooperative Agreements to up to 15 State Medicaid Agencies, facilitating widespread adoption and impact of this vital maternal health care program.
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Pillar I. Access, Infrastructure, and Workforce of the Maternal Health Care Program |
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| Problem | Model Solution |
| Limited access to the full range of maternal health care providers, restricting choice and potentially impacting quality of care. | – Increase access to birth centers and midwives, diversifying provider options and promoting patient-centered care within the maternal health care program. |
| Limited access to community-based maternity services, leaving gaps in support networks and hindering holistic maternal well-being. | – Increase access to perinatal community health workers and doulas, strengthening community-based support systems as a core component of the maternal health care program. |
| Outdated data collection methods leading to fragmented information; limited information-sharing among providers, Community Based Organizations (CBOs), and other agencies, impeding coordinated maternal health care program delivery. | – Enhance data collection, exchange, and linkage through strategic improvements in electronic health records and health information exchanges, fostering seamless information flow within the maternal health care program network. |
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Pillar II. Quality Improvement and Safety within the Maternal Health Care Program |
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| Problem | Model Solution |
| Lack of consistent implementation of evidence-informed safety practices in hospitals, contributing to potentially avoidable procedures (e.g., low-risk c-sections) within the maternal health care program. | – Implement “patient safety bundles,” – specific, evidence-based protocols designed to promote the reduction of avoidable procedures and enhance overall outcomes within the maternal health care program. – Promote achieving the recognized “Birthing-Friendly” designation, setting a quality benchmark for participating facilities within the maternal health care program. – Introduce a proactive option to promote shared decision-making between mothers and providers, empowering patient involvement in care decisions within the maternal health care program. |
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Pillar III. Whole-Person Care Delivery through the Maternal Health Care Program |
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| Problem | Model Solution |
| A “one size fits all” approach to maternal care, primarily focused on managing medical complications, often neglecting the personalized needs required to optimize overall health and wellness within the maternal health care program. | – Institute evidence-based medical and social risk assessments to drive risk-appropriate care, ensuring individualized care pathways within the maternal health care program. – Deliver care that is consistently aligned with individual preferences, respecting patient autonomy and promoting patient-centeredness within the maternal health care program. |
| Inconsistent medical risk screenings for prevalent conditions such as depression, leading to underdiagnosis and undertreatment within the maternal health care program. | – Routinely screen and provide follow-up care for perinatal depression, anxiety, and tobacco and substance use throughout both prenatal and postpartum periods, prioritizing mental health within the maternal health care program. – Incorporate home monitoring and telehealth technology for birthing people managing medical conditions like gestational diabetes and hypertension that complicate pregnancies, improving accessibility and convenience within the maternal health care program. |
| Inconsistent screenings for critical health-related social needs (HRSNs) and a lack of systematic approaches to address identified HRSNs as integral components of the overall care plan within the maternal health care program. | – Routinely screen and provide follow-up for HRSNs, recognizing their impact on maternal well-being within the maternal health care program. – Establish reliable and efficient referral pathways to and from community-based organizations to effectively address identified HRSNs, creating a robust support network within the maternal health care program. |
| Persistent disparities, including racial and ethnic disparities, coupled with a lack of comprehensive cultural competency training for providers, leading to instances where individuals feel their legitimate concerns are dismissed or ignored within the maternal health care program. | – Develop and rigorously implement Health Equity Plans as a core component of the maternal health care program, specifically targeting and mitigating disparities. – Provide ongoing cultural competency technical assistance for providers, fostering culturally sensitive and respectful care delivery within the maternal health care program. |
Health Equity Strategy of the Maternal Health Care Program
A fundamental aspect of the TMaH maternal health care program is its dedicated health equity strategy. This strategy is specifically designed to address and rectify the disparities that disproportionately affect underserved populations. These populations include racial and ethnic minority groups and individuals residing in rural areas, who consistently face a heightened risk of adverse maternal health outcomes. The model will proactively encourage participating states to extend Medicaid and CHIP postpartum coverage to 12 months. This extended coverage is a vital step in promoting continuous preventive care, safeguarding overall health, and ultimately contributing to a reduction in long-term healthcare expenditures associated with maternal health complications.
To ensure targeted and effective support, the TMaH maternal health care program will offer tailored, state-specific technical assistance. This assistance is specifically directed towards supporting providers and other crucial partners operating in rural, Tribal, and other high-need areas where resources and access may be particularly challenging. This may encompass establishing strategic regional partnerships and providing expert guidance on effectively incorporating Federally Qualified Health Centers (FQHCs) and rural health centers into both the care delivery and payment models of the maternal health care program.
Technical assistance will also be strategically focused on enhancing providers’ capabilities in several key areas crucial for effective maternal health care programs. These areas include proficiently screening for health-related social needs (HRSNs), establishing seamless referral pathways to community-based and social services, and rigorously tracking how individual needs are effectively addressed and met. Facilitating timely and appropriate referrals for identified HRSNs, encompassing essential needs such as housing, transportation, and food security, has the potential to significantly improve health outcomes and simultaneously reduce the need for avoidable and often more costly interventions in the future. Furthermore, dedicated technical assistance will be provided to support states in the comprehensive development and implementation of robust Health Equity Plans, ensuring that equity remains at the forefront of the maternal health care program.
Health Equity Plans: A mandatory requirement for SMAs participating in the maternal health care program is the development and implementation of a Health Equity Plan. These plans must be meticulously tailored to address the unique needs of their specific population. States are required to thoughtfully consider critical factors such as language support for non-native English speakers, ensuring accessible transportation services, and implementing targeted improvements to effectively address identified gaps in care delivery within their maternal health care program.
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For any inquiries or questions regarding the Transforming Maternal Health Model and its maternal health care program initiatives, please do not hesitate to contact the dedicated TMaH Model team directly at: [email protected]
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