Payment Policies to Optimize Care and Improve Equity for Postpartum People in the United States

Presented by Julia Interrante, MPH
HSRP&A Doctoral Candidate
Division of Health Policy & Management

The U.S. is in the midst of a maternal health crisis; severe maternal morbidities and mortality have increased 40% in the last decade, largely among racialized birthing people. In addition, three-quarters of all birthing people report challenges during the first year after childbirth, including breastfeeding difficulties, fatigue, pain, and depression and/or anxiety. The postpartum period is a crucial time for detection and prevention of complications. Yet in the US, postpartum care is often limited to one visit at six weeks postpartum with limited content. This is insufficient and misaligned with the timing and medical, mental health, and support needs of postpartum patients. Half of postpartum patients report not receiving all of the care they wanted and 30% report feeling rushed. Complicating this inadequacy are rampant racial, geographic, and income-based disparities in access to care and maternal outcomes.

This talk first describes disparities in postpartum care content at the intersection of health insurance type, geography, and race and ethnicity. Then it examines the impact of a value-based payment model on postpartum care and health outcomes. Finally, a cluster-analytic approach is applied to classify patterns of postpartum care utilization as a way to better understand different types of postpartum patients and better predict outcomes based on identified patterns, which could ultimately be used to leverage and develop more targeted care management and intervention strategies to improve postpartum health outcomes.