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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Cost-Sharing Partnerships

Approach. Support cost-sharing partnerships between payers, providers, and community support systems to defray expenses associated with postpartum visits

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Overview. Innovative cost-sharing partnerships between healthcare systems and Medicaid-managed care organizations can help defray the cost of employing care coordinators and provide financial incentives for clinicians to complete postpartum visits. The cost savings can also free up funds for postpartum care education for healthcare providers and enhance patient access to community resources and services. Billing and coding challenges will need to be addressed, but emerging evidence suggests that cost-sharing partnerships between payers and providers can result in a redistribution of resources that can increase postpartum visit attendance.[1,2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Collaboration (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of cost-sharing partnerships established between healthcare systems, Medicaid-managed care organizations, and community support systems to support postpartum care. (Indicates the implementation and scale of the strategy)
  • Number of care coordinators hired and trained through cost-sharing partnerships to facilitate postpartum care access and coordination. (Shows the capacity building and workforce development efforts)

OUTCOME MEASURES:

  • Number of postpartum visits completed and reimbursed through cost-sharing partnerships. (Indicates the utilization and financial outcomes of the strategy)
  • Number of postpartum complications, readmissions, and adverse health outcomes prevented or reduced through timely and comprehensive postpartum care supported by cost-sharing partnerships. (Shows the health impact and cost-saving outcomes)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of eligible healthcare systems and Medicaid-managed care organizations that participate in cost-sharing partnerships to support postpartum care. (Indicates the uptake and engagement of key partners)
  • Percent of postpartum care coordinators and providers who report increased knowledge, skills, and confidence in delivering comprehensive postpartum care as a result of education and training funded through cost-sharing partnerships. (Shows the effectiveness and quality of capacity building efforts)

OUTCOME MEASURES:

  • Percent increase in postpartum visit attendance rates among patients served by healthcare systems and providers participating in cost-sharing partnerships, compared to baseline or non-participating systems and providers. (Indicates the effectiveness of the strategy in improving postpartum care utilization)
  • Percent reduction in postpartum care costs and resource utilization (e.g., emergency room visits, hospitalizations) among patients served by cost-sharing partnerships, compared to baseline or non-participating populations. (Shows the cost-effectiveness and efficiency outcomes)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of community-based organizations, social service agencies, and other support systems engaged as partners in cost-sharing initiatives to enhance postpartum care access and coordination. (Indicates the multi-sector collaboration and integration efforts)
  • Number of policies, guidelines, and protocols developed and adopted to facilitate effective and efficient implementation of cost-sharing partnerships for postpartum care. (Shows the system-level changes and enabling factors)

OUTCOME MEASURES:

  • Number of healthcare systems and communities that achieve significant and sustained improvements in postpartum care quality, equity, and outcomes through cost-sharing partnerships. (Indicates the long-term impact and return on investment of the strategy)
  • Number of policy and funding mechanisms established at the local, state, or national level to support and sustain cost-sharing partnerships for postpartum care. (Shows the policy and systems change outcomes)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of cost-sharing partnership resources and funds allocated to address health inequities and disparities in postpartum care access and outcomes. (Indicates the equity and social justice focus of the strategy)
  • Percent of cost-sharing partnership performance and accountability measures that include patient-reported experiences, outcomes, and equity indicators. (Shows the use of comprehensive and equity-centered evaluation frameworks)

OUTCOME MEASURES:

  • Percent reduction in racial, socioeconomic, and geographic disparities in postpartum care utilization, quality, and outcomes achieved through tailored and equitable implementation of cost-sharing partnerships. (Indicates the health equity and social justice impact of the strategy)
  • Percent of overall maternal and child health system costs and burdens reduced through the prevention and early intervention effects of enhanced postpartum care access and coordination via cost-sharing partnerships. (Shows the long-term value and sustainability of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Howell, E. A., Balbierz, A., Beane, S., Kumar, R., Wang, T., Fei, K., Ahmed, Z., & Pagán, J. A. (2020). Timely Postpartum Visits for Low-Income Women: A Health System and Medicaid Payer Partnership. American journal of public health, 110(S2), S215–S218. https://doi.org/10.2105/AJPH.2020.305689.
[2] Howell, E. A., Padrón, N. A., Beane, S. J., Stone, J., Walther, V., Balbierz, A., Kumar, R., & Pagán, J. A. (2017). Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care. Maternal and child health journal, 21(3), 432–438. https://doi.org/10.1007/s10995-016-2221-8.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.