U.S. flag

An official website of the United States government

Postpartum Care

Postpartum Coverage Extension Resources

Improving Postpartum Care

maternal_health-motherandchild

Postpartum care is an important part of the continuum of reproductive care across the life cycle. Care during the postpartum period involves not just a single postpartum visit but a series of visits beginning with the birthing event and transitioning to ongoing general healthcare. More than half of pregnancy-related deaths occur in the postpartum period, and 12 percent occur after six weeks postpartum. Medicaid and CHIP programs should engage in opportunities to improve postpartum care and work to eliminate preventable maternal mortality, severe maternal morbidity (SMM), and inequities. The Centers for Medicare & Medicaid Services (CMS) offers quality improvement (QI) technical assistance to help states increase access, quality, and equity of postpartum care in Medicaid and Children’s Health Insurance Program (CHIP).

The technical assistance has two components:

  1. QI resources to help state Medicaid and CHIP staff and their QI partners begin improving postpartum care for their beneficiaries
  2. CMS’s Improving Postpartum Care learning collaborative, including approaches to improving postpartum care and state examples

For more information on these materials and other QI technical assistance, please email MedicaidCHIPQI@cms.hhs.gov.

Improving Postpartum Care: QI Resources

Here are some technical assistance tools to help states get started in developing their own QI project to improve postpartum care:

  • New: Increasing Access, Quality, and Equity in Postpartum Care in Medicaid and CHIP: A Toolkit for State Medicaid and CHIP Agencies. This toolkit provides practical information to help state Medicaid and CHIP agencies maximize the use of existing authorities to increase postpartum care access, quality, and equity for Medicaid and CHIP beneficiaries. The toolkit also includes a strategy checklist and suggestions for partnering with Medicaid and CHIP managed care plans (MCPs) to implement QI strategies.
  • Improving Postpartum Care for Medicaid and CHIP Beneficiaries: Getting Started on Quality Improvement. This video provides an overview of how Medicaid and CHIP agencies can start a QI project to improve postpartum care. The Model for Improvement begins with small tests of change, enabling state teams to “learn their way” toward strong programs and policies.
  •  Improving Postpartum Care Driver Diagram and Change Idea Table. A driver diagram is a visual display of what “drives” or contributes to improvements in postpartum care. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to improve postpartum care) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes change idea tables, which contains examples of evidence-based or evidence-informed postpartum care QI interventions. The change ideas were tailored for Medicaid and CHIP.
  • Improving Postpartum Care Measurement Strategy. This measurement strategy provides examples of measures that can be used to monitor postpartum care QI projects.
  • Postpartum Coverage Extension Improving Maternal Health During the Postpartum Period (video) (transcript). In March 2022, CMS presented a webinar that described the clinical and social risks postpartum individuals face that contribute to their morbidity and mortality and strategies to improve postpartum care and outcomes. This webinar also looked at how the American Rescue Plan’s Medicaid and CHIP 12-month postpartum extension option provides the time and access to care needed to better meet the needs of postpartum individuals.

For more information on these materials and other QI technical assistance, please email MedicaidCHIPQI@cms.hhs.gov.

Improving Postpartum Care Learning Collaborative

In 2021, CMS launched the Improving Postpartum Care learning collaborative to support state Medicaid and CHIP agencies’ efforts to improve health outcomes during the postpartum period. The learning collaborative included a webinar series and an affinity group. Links to the webinars are listed below.

Kentucky, Georgia, Oklahoma, South Carolina, Texas, Kansas, Missouri, Montana and Wyoming participated in the action-oriented affinity group where teams designed and implemented a postpartum care quality improvement (QI) project in their state. Results from states that participated are featured in the highlights brief and state spotlights webinar (below).

Learning Collaborative Webinar Series

  • State Spotlights: Improving Postpartum Care (video, transcript). From April 2021 through April 2023, the CMS Medicaid and CHIP quality improvement technical assistance program supported nine states participating in the Improving Postpartum Care affinity group with information, tools, and expert support to improve postpartum care for Medicaid and CHIP beneficiaries. This May 2023 webinar spotlighted several state QI projects from the affinity group, highlighting their strategies, partnerships, and lessons learned.
  • Maintaining Coverage and Access to Care During the Postpartum Period (audio, transcript). This January 2021 webinar described strategies to ensure coverage and access to care during the postpartum period for women at high risk of postpartum complications. Shannon Lovejoy and Jessica Stephens from CMCS described existing Medicaid and CHIP requirements for continuing coverage in the postpartum period including beyond 60 days after delivery.  Tom Curtis from the Michigan Department of Health and Human Services presented Michigan’s approach to reporting visit rates by race and ethnicity to monitor disparities in postpartum care visit attendance as a performance measure. 
  • Improving the Content of Care During the Postpartum Period (audio, transcript). This webinar focused on the changing concept of postpartum care and the emphasis on risk reduction for maternal health, both in the immediate postpartum period and in the extended postpartum period up to one year after delivery. Beth Tinker and Judy Zerzan from the Washington State Health Care Authority and Cameual Wright from an Indiana Medicaid managed care plan presented best practices to improve postpartum care visit rates and the content of care including contraceptive care, management of chronic diseases, and social risks as well as opportunities for value-based care. Presenters highlighted the need to address risks in specific high-risk populations.
  • Models of Women-Centered Care (audio, transcript). This webinar focused on strategies for providing women-centered care for Medicaid and CHIP beneficiaries and offer state examples of how these models can improve postpartum care for women at high risk of postpartum complications and also eliminate disparities in maternal and infant health outcomes. Susan Beane and Rashi Kumar from a New York Medicaid managed care plan, Mary LeMieux from the Montana Department of Public Health and Human Services, and Nathan Chomilo from the Minnesota Department of Human Services discussed the use of doulas, team-based care, group care, and community partnerships to improve care. The presenters also discussed payment strategies to support these care models.

Postpartum Care Action Learning Series

The focus of the series from 2013-2014 was to build Medicaid/CHIP capacity for quality improvement by providing voluntary training and support for teams that wanted to get started or continue implementing a specific quality improvement (QI) project around maternal and infant health. Teams were guided in implementing rigorous QI projects designed to start producing results within a ten-month timeframe.

Materials from the series include: