ACA Can Build Upon CHIPRA Success by Improving Maternity Care – Say Ahhh! A Children’s Health Policy Blog

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By Amanda Jezek, March of Dimes

Health reform has the potential to provide tremendous
opportunities to expand health insurance coverage, but what many people do not
realize is that the new law also makes significant investments designed to
improve the quality of health care — particularly in Medicaid.  These provisions are critical in making
sure that care provided to Medicaid beneficiaries meets the highest standards
of evidence and follows clinical care guidelines.  

Quality measurement and reporting can provide a
comprehensive snapshot of how well Medicaid is serving the women, children,
families and others who rely upon the program, and identify areas where
improvements can be made.  These
efforts hold great promise for the
millions of people who will enter Medicaid in 2014, and also for the millions
more who currently depend upon the program — including a huge number of
pregnant women.

HHS posted for comment in the Federal Register a proposed initial core set
of adult quality measures for use in Medicaid.  The Affordable Care
Act calling for this action mirrored language in the Children’s Health
Insurance Program Reauthorization (CHIPRA) which established the precedent by
initiating the selection and dissemination of a core set of pediatric quality measures.  Health reform presents an important
opportunity to build upon CHIPRA’s efforts, particularly with regard to
maternity care. 

Given that
Medicaid finances more than 41 percent of births nationwide, maternity care is
a common sense area of focus.  In
fact, the proposed core set of adult measures includes the following four of
great importance to pregnant women. 
These measures are well established and have been recommended for use by
 several national organizations that specialize in  measure
development and use:

  1.  Elective deliveries between 37 and 39 weeks
    gestation:  A January 2009 study
    published in the New England Journal of Medicine, found that elective Cesarean
    sections and inductions before 39 weeks pose significant risks to infants’
    health, including respiratory problems, feeding difficulties, infections, and
    higher rate of neonatal intensive care unit (NICU) admissions.i  These increased health problems led to
    higher rates of utilization of health care services and ultimately higher
    health care costs. The final weeks of pregnancy are a very important period of
    fetal lung development and brain growth and the health consequences for
    children born 37-39 weeks gestation with no medical indication can be
    significant and require costly care.
  2. Pregnant women at risk of preterm delivery at 24-32
    weeks gestation receiving antenatal corticosteroids prior to delivery:  Antenatal corticosteroids are typically
    recommended for women at risk, or experiencing preterm labor, to help the
    fetus’s lungs mature so that he or she can breathe more easily after birth.
    Corticosteroids reduce breathing problems in newborns and help prevent a
    serious lung condition called respiratory distress syndrome. Corticosteroids
    also help prevent bleeding in the newborn’s brain and a serious bowel disease
    called necrotizing enterocolitis. 
  3. Medical assistance with smoking and tobacco use
    cessation:  This is critically
    important for pregnant women and particularly timely given that states are now
    required to cover tobacco cessation counseling for pregnant women in
    Medicaid.  Inclusion of this
    measure can help ensure that states are in compliance with the new federal law
    and help improve the quality of cessation services.  Women who smoke during pregnancy are more likely than
    nonsmokers to have a low birthweight or preterm baby.  According to the American College of Obstetricians and
    Gynecologists (ACOG), it is estimated that eliminating smoking during pregnancy
    would reduce infant deaths by 5 percent and reduce the incidence of singleton
    low birth weight infants by 10.4 percent. 
    Pregnant women enrolled in 
    Medicaid are 2.5-times more likely to smoke than other pregnant women
    according to data collected by the Centers for Disease Control and Prevention
  4. Postpartum care: 
    This measure captures the percentage of women who had a postpartum visit
    21-56 days after delivery. 
    Postpartum care has been shown to help women improve appropriate spacing
    for subsequent pregnancies, reducing the risk of preterm birth which can be
    devastating for families as well as extremely costly.  In fact, a recent Institute of Medicine report estimates
    that the societal economic cost of preterm birth totaled at least $26.2 billion
    in 2005, the latest year for which data is available.  The medical component of that total was $18.8 billion – 85
    percent of which was health services provided to infants.  The IOM Committee estimates that more
    than half of these medical costs are borne by Medicaid and other public

The proposed adult core measure set has been released for
public comment, and its final composition may change as a result of those
comments.  Stakeholders who care
about the quality of maternity care in the Medicaid program should encourage
HHS to include the above quality measures in the final version of the  initial core set. 

State reporting on quality measures in the core set is
voluntary, so it is also important 
that states be strongly encouraged to adopt and report on these
measures.  Some states are already
doing so, and  others can begin
right away. 

The data obtained through quality measurement and reporting
provides an enormously useful body of information for  to federal and state policy makers, consumers, health
providers, payers and advocates that can be used to improve the care provided
to pregnant women in Medicaid. 
Improved care can ultimately result in better health outcomes for
mothers and their children. 
Healthier families — for which health  coverage is only one factor –should ultimately be the true
goal of health reform.

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