Prenatal and Postpartum Care

WHA reports two access to care rates for women; Prenatal Care and Postpartum Care. The Plan level HEDIS measure rates are reported to National Committee for Quality Assurance (NCQA), and the screening rates by Medical Group/IPA are reported to IHA for the Pay for Performance (P4P) Provider Incentive Program.  

Early prenatal care with ongoing risk assessment helps to ensure appropriate care for all patients, to ensure good use of available resources, and to improve the outcome of pregnancies. Outcome data suggests that babies born to mothers who do not receive prenatal care are 3 times more likely to be of low birth weight, and 5 times more likely to die, compared with babies born to mothers who receive prenatal care. 

All patients should be evaluated within the first trimester of pregnancy by an obstetrician, nurse midwife, family practitioner or other primary care practitioner providing perinatal services. This initial encounter’s documentation should include: date prenatal care was initiated, date of LMP and EDD.

The HEDIS measure specifications for MY2022 include:

Deliveries of live births on or between October 8, 2021 to and October 7, 2022.

• Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit the first trimester.
• Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

WHA’s HEDIS Screening Rates

WHA’s rates improved for MY2022.  Prenatal Care and Postpartum Care performance rate now ranks WHA in the NCQA 25th - 50th percentile nationally.

Looking at Lack of Prenatal and Postpartum Care

A report, released by the infant and maternal health nonprofit March of Dimes, found that between 2020 and 2022, 5% of US counties reduced maternity care access, but only 3% of counties shifted to increased access to care.¹

Prior to childbirth, racial and ethnic disparities in maternity care exist. One in four Native American women (24.2%) and 1 in 5 Black women (20.1%) did not receive adequate prenatal care in 2020, compared to only 1 in 10 White women (9.9%). Additionally, Hispanic, Asian, and Pacific Islander women were less likely to receive adequate prenatal care when compared to White women (17.3 and 11.3%, respectively).

After childbirth, differences in health outcomes for minority women persist. In 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, nearly three times the rate for non-Hispanic White women. Additionally, severe maternal morbidity (SMM), or unexpected outcomes of labor and delivery that result in significant short or long-term health consequences, affects approximately 50,000 women in the U.S. each year.

Currently, as many as 40% of women do not attend a postpartum visit. Underutilization of postpartum care impedes the management of chronic health conditions and access to effective contraception, which increases the risk of short interval pregnancy and preterm birth. Attendance rates are lower among populations with limited resources ^{2, 3}, which contributes to health disparities.

In a national survey, less than one-half of women attending a postpartum visit reported that they received enough information at the visit about postpartum depression, birth spacing, healthy eating, the importance of exercise, or changes in their sexual response and emotions ^4.

Reference:

¹ Nowhere to go: Maternity Care Deserts Across the U.S. (2022 REPORT); https://www.marchofdimes.org/maternity-care-deserts-report

² Centers for Disease Control and Prevention. Lactational amenorrhea method. In: US medical eligibility criteria (US MEC) for contraceptive use. Atlanta (GA): CDC; 2017.

³ Reproductive life planning to reduce unintended pregnancy. Committee Opinion No. 654. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016; 127: e66–9.

4 MacArthur C, Winter HR, Bick DE, Lilford RJ, Lancashire RJ, Knowles H, et al. Redesigning postnatal care: a randomized controlled trial of protocol-based midwifery-led care focused on individual women's physical and psychological health needs. Health Technol Assess 2003; 7:1–98.