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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...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of cost-sharing partnerships organized by Title V 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)

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

  • Percent of cost-sharing partnerships organized by Title V established between healthcare systems, Medicaid-managed care organizations, and community support systems to support postpartum care. (Indicates the implementation and scale of the strategy) Percent 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)

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

  • 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 that report high levels of engagement. (Indicates the multi-sector collaboration and integration efforts) Number of policies, guidelines, and protocols promoted by Title V developed and adopted to facilitate effective and efficient implementation of cost-sharing partnerships for postpartum care. (Shows the system-level changes and enabling factors) Number of healthcare systems and communities that achieve significant and sustained improvements in postpartum care quality 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?”)

  • Percent 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 that report high levels of engagement. (Indicates the multi-sector collaboration and integration efforts) Percent of policies, guidelines, and protocols promoted by Title V developed and adopted to facilitate effective and efficient implementation of cost-sharing partnerships for postpartum care. (Shows the system-level changes and enabling factors) Percent of healthcare systems and communities that achieve significant and sustained improvements in postpartum care quality and outcomes through cost-sharing partnerships. (Indicates the long-term impact and return on investment of the strategy) Percent 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)

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.