Primary Submission Category: Health care/services
A Conceptual Model for Alternative Payment Models in Maternity Care
Authors: Lastascia Coleman
Presenting Author: Lastascia Coleman*
The delivery of maternity care has received much needed attention in the last several years, with a notable influx state and federal programs that intend to impact and improve maternal health outcomes. These initiatives include perinatal quality collaboratives, state maternal mortality review committees, Medicaid expansion and extension, and Maternal Levels of Care. Despite emphasis and funding directed at supporting and initiating these programs, maternal morbidity and mortality continue to increase in the US. None of these programs fully address the Quintuple Aim which may be contributing to the lack of progress. In addition to the elements of the Triple Aim of population health, cost effective care, and patient experience, the Quintuple Aim also include workforce issues and health equity.
One barrier to improving maternal health outcomes that has not been addressed thoroughly is exploring the role of alternative payment models (APMs) that encourage improvements and collaboration between payers and birthing units. Linking insurance reimbursement to improved outcomes through APMs has been successful in Medicare programs and several states now operate accountable care organizations (ACOs) through Medicaid as well. When APMs were originally implemented with the Affordable Care Act, the Triple Aim was used as the framework to create these models. A model such as this would allow for a more comprehensive approach to care that brings multiple stakeholders to the table. A critical review of the existing literature on APMs, examination of current quality indicators, and barriers to success will be reviewed in this presentation. This research is ongoing and will conclude in May of 2023.