The Get Well Team
There’s a golden opportunity waiting for state Medicaid agencies wanting to close gaps in maternal health care and foster lasting change. Through the CMS Transforming Maternal Health (TMaH) Model for Medicaid plans, up to $17 million—per state agency—is on the table. This is a 10-year program designed to improve maternal health care for Medicaid and CHIP beneficiaries. But the time to act is now. Submissions are due September 20, 2024.
This critical maternal health initiative is incredibly timely as, not only does the U.S. rank dead last among wealthy nations when it comes to maternal mortality, data shows it has gotten worse over the past two decades.
That said, we should mention a blip on the radar: a May 2024 CDC study revealed a surprising finding, although one that certainly appears to be an outlier: the U.S. maternal mortality rate had actually seen an improvement from 2021-2022. (However, analysts are quick to point out that it is more than likely that the decrease was associated with declines in COVID-19 infections and to be aware that the report did not examine why the numbers went down.)
This single study finding aside, it surely will be no surprise to those well-acquainted with maternal health disparities that the study also showed Black women continue to suffer the most. The data showed that the maternal mortality rate for Black women was 49.5 deaths per 100,000 live births: compare that with 19.0 for White women, 16.9 for Hispanic women and 13.2 for those of Asian descent.
Women from rural areas, regardless of their race or ethnicity, also are at a higher risk of maternal mortality, due to the closing of women’s health services at rural hospitals. These women can also significantly benefit from the funding opportunity available through the TMaH Model.
The Three Pillars of the TMaH Model
One piece of good news is the fact that agencies will not only receive funds, but assistance all along the way. To begin, each agency will be supported by a technical assistance (TA) coach to draft a TA plan as well as receive three years of personalized TA during the pre-implementation phase.
“The focus is on the fact that you have to have the infrastructure in place, and I love that,” said Chelsea King Arthur, DrPH, VP of Population and Digital Health at Get Well. “This is a long-running project and there is a lot of work that can be done, which can translate into lasting policy changes and lasting care models. That’s exciting.”
The TMaH’s model focuses on three pillars, which will advance maternal health on multiple fronts. These are:
- Access to care, infrastructure, and workforce capacity: Using TMaH funding, state Medicaid agencies (SMAs) will be able to support relationship building and education to address barriers to accessing midwives, doulas and perinatal Community Health Workers (CHWs). This increased access can lead to reduced cesarean sections, shorter labor times, lower pain medication use, and decreased postpartum anxiety and depression.
- Quality improvement and safety: State Medicaid agencies will be able to implement quality initiatives and protocols known as “patient safety bundles” to enhance childbirth safety and improve outcomes for both mothers and babies. These evidence-based interventions address issues such as hypertension, cardiac conditions and care for those with substance use disorders. SMAs will also be able to aim for the CMS “Birthing-Friendly” designation.
- Whole-person care delivery: With this funding, SMAs can help ensure that every mother receives personalized care tailored to their needs through the development of individualized birth plans. Initial prenatal screenings will identify additional support needs for health-related social needs, mental health, or substance use disorders. Care plans will be developed collaboratively, with options for remote monitoring and connections to community resources to ease the burden of travel and enhance overall support.
Steps Forward
Building upon all three pillars will help strengthen maternal health care in states, but SMAs should take time to consider the best pathways to reach their goals. For example, some, if not all, SMAs may find that building upon Pillar #1 is particularly challenging. That’s because—while it is a worthy goal to aspire to—finding, scaling up and retaining a robust workforce of doulas, midwives and CHWs may be difficult or near-impossible in some geographies. Reports seem to suggest it won’t get easier anytime soon. (Read: “Health Workforce Challenges Impact the Development of Robust Doula Services for Underserved and Marginalized Populations in the United States.”)
When deciding how best to proceed, SMAs should consider that digital-first member engagement solutions that support prenatal, birth, and postpartum aspects of the patient journey can be an effective and powerful way to improve on these pillars.
“We can use digital technology and AI in order to be readily accessible,” says King Arthur. “We can also use it to educate and allow women to ask questions as well as express their symptoms in a way that they are heard.”
Get Well’s Maternal Health Solution
When it comes to pillars #2 and #3, Get Well’s Maternal Health Equity solution—one of the organization’s highest rated programs—can play a pivotal role and help state agencies scale up efficiently, and help make the most of these funds and have a wide impact.
Get Well’s program can run from seven weeks of pregnancy to eight weeks postpartum, and along the way, there are dozens of touchpoints, giving mothers additional pathways to ask questions or understand which symptoms are concerning.
King Arthur explains just one of the ways the program goes beyond to bring benefits.
“Although ACOG [the American College of Obstetricians and Gynecologists] recommends one visit after birth, we have several touchpoints. We follow up with them on topics like breastfeeding, we ask about any concerning new signs or symptoms. We also ask about their mental health or if they have any social needs that have come up. One message we have heard often is that we help mothers feel like they weren’t forgotten.”
There is no denying that the statistics surrounding maternal health disparities are sobering and steps ahead often feel few and far between. While TMaH funding won’t rapidly solve each and every long-standing issue, this initiative offers much more than lip service or a bandage solution, and together with leveraging resources such as scalable digital solutions, it could help lead to the new and better results—healthier mothers, healthier babies and healthier families—that we all are looking for.
Are you looking to explore or evaluate a solution for maternal health equity and improvement? Download our RFP Template for Maternal Health Equity solutions here.
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