Collaboration increases postpartum visits for low-income, high-risk mothers
Click Here to Manage Email Alerts
A partnership between a health system and a Medicaid payer increased postpartum visits among high-risk, low-income new mothers in New York City, according to a report in the American Journal of Public Health.
“We chose to implement this intervention based on my team’s previous research aimed at reducing positive depression screens and improving health outcomes among low-income women of color,” Elizabeth Howell, MD, MPP, director of the Blavatnik Family Women’s Health Research Institute at Mount Sinai Hospital in New York, told Healio Primary Care.
The intervention was supported by a grant from the Robert Wood Johnson Foundation. It consisted of social workers and community health workers providing new mothers with educational materials, calling 1 to 2 weeks after delivery and making up to 12 additional phone calls based on their needs.
“Our [intervention] provided education about hypertension, gestational diabetes, depression, nutrition, exercise and common postpartum symptoms,” Howell said. “It also taught self- management skills, enhanced social support and connected patients with community resources and health care services.”
The intervention also included a cost-sharing arrangement between Mount Sinai Hospital and Healthfirst to cover employee-related costs. One year following the start of the intervention, Healthfirst also provided $10 in the form of enhanced payments for each completed postpartum visit. The new mothers received round-trip public transportation and small financial incentives of $10 for attending a postpartum visit.
Howell and colleagues enrolled 506 new mothers into the intervention. Among them, 29% spoke Spanish, 13% had hypertension, 10% had diabetes and 3% had depression or mental illness.
The researchers assessed how many postpartum visits were completed by the 363 women who were eligible for a visit with an obstetrics or primary care physician between 21 and 56 days post-delivery. They also evaluated how many women had enrolled in a Medicaid plan at 6 and 12 months postdelivery. The data were analyzed alongside a comparable group of new mothers in an approximate 2:1 control-to-intervention ratio.
Howell and colleagues found that participants in the intervention group had higher rates of postpartum visits within the studied timeframe vs. participants in the control group (66.9% vs. 56%; P < .001). Intervention participants also had higher rates of postpartum outpatient or gynecologic care up to 90 days after delivery (90.2% vs. 83.4%; P = .002) and were more likely than non-intervention participants to be enrolled in a Medicaid care plan 6 months after delivery (79.1% vs. 73.3%; P =.015). They were also more likely to be enrolled in the Medicaid plan 12 months after delivery (71% vs. 66.3%; P = .067), but this finding was not significant.
“Our [intervention] demonstrated the importance of including multiple stakeholders, patient education, care coordination and community and medical resources to implement a successful new care model,” Howell said. “It also demonstrated a successful health system and payer partnership aimed at reducing disparities.”
Editor’s note: Photo courtesy of Mount Sinai Health System.