Prenatal and Postpartum Care: Postpartum Care

About This Measure

This measure reports state performance based on the percentage of deliveries of live births that had a postpartum care visit between 21 and 56 days after delivery. Postpartum visits within this time frame are timely. Higher rates are better.

The data presented below are taken from the Adult Core Set for Federal Fiscal Year (FFY) 2016. Reporting is currently voluntary and reporting methods can vary by state.  For example, some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care. This variation in data availability can impact measure performance. Readers should review the detailed measure notes located after the graph to better understand states’ reported rates.

Medicaid is the largest payer for maternity care in the United States. The program has an important role to play in improving maternal and perinatal health outcomes. Postpartum visits provide an opportunity to assess a woman’s physical recovery from pregnancy and childbirth and to address:

  • Chronic health conditions, such as diabetes and hypertension
  • Mental health status, including postpartum depression
  • Family planning, including contraception and inter-conception counseling

Timely postpartum care is defined as happening between 21 and 56 days after delivery.

The red dashed line represents the median, or middle of all values reported.

m05

Stem plot with a median of 54% and the states and values:

State Percent
Alabama 46%
Colorado 50%
Connecticut 64%
Dist. Of Col. 49%
Delaware 56%
Georgia 58%
Hawaii 51%
Iowa 35%
Illinois 54%
Kentucky 54%
Louisiana 52%
Massachusetts 70%
Maryland 72%
Michigan 53%
Minnesota 41%
Missouri 39%
Mississippi 58%
Montana 34%
North Carolina 33%
New Hampshire 66%
New Jersey 57%
New Mexico 51%
Nevada 55%
New York 70%
Ohio 48%
Oklahoma 21%
Oregon 51%
Pennsylvania 64%
Rhode Island 74%
South Carolina 54%
Tennessee 56%
Texas 63%
Utah 66%
Virginia 65%
Washington 52%
West Virginia 59%

Source: Mathematica analysis of MACPro reports for the Adult Core Set FFY 2016 reporting cycle; see 2016 Child and Adult Health Care Quality Measures.

Notes:

The following states did not report data to CMS for this measure: AK, AR, AZ, FL, ID, IN, KS, ME, ND, NE, SD, VT, WI, and WY.

This figure excludes CA, which did not use Adult Core Set specifications to calculate the measure.

Measure Specific Tables (MSTs) available on Medicaid.gov provide important context for understanding state performance on each measure. MSTs include information about variation in included populations, methods, and data sources used to calculate the measure, as well as deviations from Core Set measure specifications.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on HEDIS 2016 specifications. The following state used HEDIS 2015 specifications: NV.
  • The measurement period for this measure was November 6, 2014 to November 5, 2015. MN, MS, and NV reported data for CY 2015; MT reported data for FFY 2015.

The Adult Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records.

Denominators are assumed to be the measure-eligible population for states using the administrative method; states using the hybrid method often reported the sample size for the medical chart review rather than the measure-eligible population. Some states reported exclusions from the denominator, as noted in the state-specific comments below.

State-Specific Comments:

AL: Rate includes FFS and PCCM populations who were eligible for full Medicaid benefits. State used vital records to confirm live births.

CO: Rate includes FFS, PCCM, and managed care populations (1 MCO), representing 98 percent of the population. Rate excludes population in 1 MCO (representing 2 percent of the Medicaid population) as well as the CHIP population. Rate was derived using both administrative and hybrid method data. The rate for FFS and PCCM populations was calculated using the administrative method. The rate for the managed care population was calculated using the hybrid method. Denominator is the measure-eligible population. Rate was calculated by the state's EQRO.

CT: Rate includes FFS population. Rate excludes Medicare-Medicaid Dual Eligibles. Denominator is the sample size; measure-eligible population is 13,395.

DE: Rate includes managed care population (2 MCOs), representing 85 percent of the population. Rate excludes FFS population, representing 15 percent of the population. Denominator is the sum of the samples for the MCOs; measure-eligible population is not available.

DC: Rate includes managed care population (4 MCOs), representing 77 percent of the population. Rate excludes FFS population, representing 23 percent of the population. Denominator is the sample size; measure-eligible population is 3,125.

GA: Rate includes managed care population (4 MCOs), representing 96 percent of the population. Denominator is the sample size; measure-eligible population is 57,106.

HI: Rate includes managed care population (5 MCOs). Denominator is the sum of samples for the MCOs; measure-eligible population is 6,502. Rate was calculated by the state's EQRO.

IL: Rate includes FFS, PCCM, and managed care populations (13 MCOs). Rate excludes deliveries covered by bundled service claims because they do not have sufficient specificity. Rate includes paid and rejected claims, but excludes pending claims because they are adjudicated in sufficient time to not impact measurement. State does not use LOINC codes. State used ICD-10 codes and CPT codes to identify deliveries. Rate was audited by the state's EQRO.

IA: Rate includes FFS, PCCM, and managed care populations (1 MCO). Rate excludes Medicare-Medicaid Dual Eligibles. Rate includes only non-bundled payment visits that can be verified using claims data.

KY: Rate includes managed care population (5 MCOs), representing 81 percent of the population. Rate excludes FFS population, representing 19 percent of the population. Denominator is the sample size; measure-eligible population is not available. Rate was calculated by the state's EQRO and data analytics contractor.

LA: Rate includes FFS and managed care populations (5 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. Denominator is the sample size; measure-eligible population is 34,392.

MD: Rate includes managed care population (8 MCOs), representing 75 percent of the population. Rate excludes FFS population (representing 25 percent of the population), including Medicare-Medicaid Dual Eligibles, individuals eligible on the basis of age or disability, and individuals in the Rare and Expensive Case Management program. Denominator is the sample size; measure-eligible population is 20,839. Rate was calculated by the state's EQRO.

MA: Rate includes managed care population (5 MCOs), representing 51 percent of the population. Rate excludes PCCM and FFS populations (representing 49 percent of the population), but most FFS beneficiaries would not be eligible for the measure, including beneficiaries who have other insurance (commercial or Medicare), reside in a long-term care institution, or receive limited or temporary Medicaid benefits. Denominator is the sum of samples for the MCOs; measure-eligible population is 13,566.

MI: Rate includes FFS and managed care populations (13 MCOs). Rate excludes beneficiaries who had other insurance (commercial or Medicare). Data source is the state Data Warehouse, which contains MMIS data as well as state vital records. State used vital records combined with claims and encounter data to identify live births.

MN: Rate includes FFS and managed care populations (8 MCOs). Rate includes paid claims only.

MS: Rate includes managed care population (2 MCOs), representing 68 percent of the population. Rate excludes FFS population (representing 32 percent of the population) as well as Medicare-Medicaid Dual Eligibles. Denominator is the sample size; measure-eligible population is 18,729.

MO: Rate includes populations with FFS, managed care (3 MCOs), or both FFS and managed care coverage during the year.

MT: Rate includes FFS population.

NV: Rate includes managed care population (2 MCOs), representing 67 percent of the population. Rate excludes FFS population, representing 33 percent of the population. Denominator is the sample size; measure-eligible population is 9,823. Rate was calculated by the state's EQRO.

NH: Rate includes managed care population (2 MCOs), representing 79 percent of the population. Rate excludes FFS population (representing 21 percent of the population) as well as Medicare-Medicaid Dual Eligibles from 1 MCO. Denominator is the sample size; measure-eligible population is 3,065.

NJ: Rate includes managed care population (5 MCOs), representing 88 percent of the population. Rate excludes FFS population (representing 12 percent of the population) as well as Medicare-Medicaid Dual Eligibles. Denominator is the sample size; measure-eligible population is 22,702.

NM: Rate includes managed care population (4 MCOs), representing 92 percent of the population. Rate excludes FFS population, representing 8 percent of the population. Denominator is the sample size; measure-eligible population is 12,378.

NY: Rate includes managed care population (18 MCOs), representing 77 percent of the population. Rate excludes FFS population, representing 23 percent of the population. Denominator is the sample size; measure-eligible population is 90,190.

NC: Rate includes FFS and PCCM populations.

OH: Rate includes FFS and managed care populations (5 MCOs).

OK: Rate includes FFS and PCCM populations. Rate excludes home- and community-based services waiver enrollees, representing 9 percent of the adult Medicaid population. The majority of the state's providers use global codes for prenatal and postpartum visits and rate was calculated without global codes. As a result, rate may be underestimated. Rate with global billing codes included is 68 percent. State used a continuous enrollment criterion of any number of allowable gaps up to 45 days.

OR: Rate includes managed care population (16 CCOs), representing 77 percent of the population. Rate excludes the FFS population, representing 23 percent of the population. Denominator is the sample size; measure-eligible population is 16,919. State calculated the measure using EHRs. Measure-eligible population includes the measure-eligible enrollees with available EHR data.

PA: Rate includes managed care population (9 MCOs). Denominator is the sum of the samples for the MCOs; measure-eligible population is 40,829. Data were submitted by MCOs and compiled by the state's EQRO.

RI: Rate includes managed care population (2 MCOs), representing more than 90 percent of the population. Rate excludes FFS population (representing less than 10 percent of the population) as well as Medicare-Medicaid Dual Eligibles. Denominator is the sample size; measure-eligible population is 4,377.

SC: Rate includes FFS and managed care populations (6 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

TN: Rate includes managed care population (4 MCOs). Denominator is the sample size; measure-eligible population is 36,784. Rate was calculated by the state's EQRO.

TX: Rate includes FFS and managed care populations (24 MCOs). Rate was derived using both administrative and hybrid method data. STAR plans used the hybrid method and STAR HEALTH, STAR PLUS, and FFS used the administrative method to calculate the measure. Denominator is the measure-eligible population. Rate was calculated by the state's EQRO.

UT: Rate includes managed care population (4 MCOs), representing 74 percent of the population. Rate excludes FFS population, representing 26 percent of the population. Denominator is the sample size; measure-eligible population is 7,357. Data source is audited HEDIS data submitted by the MCOs to the state.

VA: Rate includes managed care population (6 MCOs), representing 36 percent of the population. Rate excludes FFS population (representing 22 percent of the population) as well as Medicaid beneficiaries eligible only for limited benefits, Program of All-Inclusive Care for the Elderly (PACE) enrollees, and Medicare-Medicaid Dual-Eligibles (representing 42 percent of the adult Medicaid population). State obtained rate from the Quality Compass and denominator is not available.

WA: Rate includes managed care population (5 MCOs), representing 88 percent of the population. Rate excludes FFS population (representing 12 percent of the population), Medicare-Medicaid Dual Eligibles, and other beneficiaries with third party liability. Denominator is the sum of the samples for the MCOs; measure-eligible population is 23,700.

WV: Rate includes managed care population (4 MCOs), representing 44 percent of the population. Rate excludes FFS population, representing 56 percent of the population. Denominator is the sample size; measure-eligible population is 7,147. Rate was calculated by the state's EQRO and data analytics contractor.