Large Employers Aim to Drive Change in Maternal Health and Maternal Mental Health Through Insurer Agreement Requirements.
Private insurers cover over 50% of U.S. births.1 To direct quality improvement and payment initiatives to drive improvements in care, the Purchaser Business Group on Health (PBGH), partners with public and private players to drive systems change and align Medicaid and employer/purchaser initiatives. PBGH members collectively spend more than $350 billion annually buying health care for their employees.
This month PBGH members released the first Comprehensive Maternity Care (CMC) Common Purchasing Agreement (CPA) which aims to improve maternity care quality and outcomes. The CMC was developed by the Comprehensive Maternity Care Workgroup which was co-led by Walmart and Qualcomm (whose benefit leader has been engaging with the Policy Center for several years).
The workgroup articulated several “attributes” and “principles” to define Comprehensive Maternity Care.
Attributes
Attributes which address mental health include (taken verbatim from the CPA):
Team-based
Patients receive care from a primary maternity care provider, such as an OBGYN, midwife or family medicine doctor, who is supported by and supports members of an interdisciplinary care team, such as doulas, mental health specialists, maternal fetal medicine specialists, lactation consultants, pediatricians, family planning specialists, primary care providers or community health workers. Under the direction of the maternity care provider, care team members communicate and coordinate to address patients’ needs and provide care appropriate to their training and expertise.
Accountable
The performance of maternity providers and their provider partners is measured and incentivized to ensure optimal maternal and infant outcomes are achieved. Measurement includes access to care, physical and mental health outcomes, patient-reported outcomes and experience and stratification by self-reported race, ethnicity, language, socioeconomic status, sexual orientation and gender identity.
Attributes are considered aspirational targets.
Principles
Principles, including the detailed actions related to maternal mental health, are listed below. Principles address standardized purchasing practices and performance measures for employers and healthcare purchasers to drive better maternity care services:
Principle 1: Equitable care that promotes cultural humility and respect
Related mental health actions include:
Plan/provider requirements:
Proposed Purchasing Agreements: The health plan/provider shall take the following steps to ensure adequate access to high-quality pregnancy and postpartum care based on the personal characteristics of the member, including but not limited to race, ethnicity, language, socioeconomic status, sexual orientation, gender identity or health conditions:
Collect and report relevant cultural and linguistic data from in-network maternity care providers and care professionals and include that information in provider directories. The health plan shall commit to recruiting in-network diverse providers and care professionals, including physicians, midwives, doulas, mental health providers and lactation consultants, that reflect the ethnic/racial/gender/LGBTQ+ makeup of the lives it covers.
Principle 2: High-quality care and payment for evidence-based care models and care coordination that optimizes favorable and equitable clinical outcomes.
Related mental health actions include:
- Ensure access to mental health and substance use disorder (SUD) care by providing adequate coverage for mental health services, including virtual care options.
- Reimburse for mental health screenings that may include but are not limited to depression, anxiety, substance use and intimate partner violence.
- Provide adequate network access to mental health providers with expertise in perinatal mood and anxiety disorders and substance use disorder by taking the following actions:
• Accurate Payment Structure: Establish a transparent payment structure that adequately enables reimbursement for mental health and substance use disorder screenings and closed loop referrals outside of the global obstetrical billing fee – i.e., reimburse for mental health screenings separate from other obstetrics fees.
• Provider education and training: Provide or pay for comprehensive education and training opportunities for mental health providers to enhance their proficiency in diagnosing and treating perinatal mood and anxiety disorders and substance use disorder. Incentives shall be offered to encourage mental health providers to actively participate in these educational activities.
• Work to expand in-network treatments: Include in-network perinatal behavioral health specialists that offer a range of service options, including care such as virtual consultations, group therapy sessions and peer support
Principle 3: Access to timely patient-centered care, including resources for members living in maternity deserts.
- Provide coverage for safe and effective virtual or hybrid models of maternity care, including maternity mental health experts and doulas, that coordinate with the patient’s usual source of care and maternal care team to ensure care is coordinated.
Principle 4: Accountability and transparency through the use of data on quality, patient-reported outcomes and patient experience stratified by race, ethnicity and language (REaL) and sexual orientation and gender identity (SOGI) indicators.
Principle 5: Value-based payments that enable maternity care providers to deliver equitable, timely, affordable, high-quality, patient-centered maternal and infant care and that hold providers accountable for delivering coordinated, evidence-based services and for reducing avoidable complications.
The Policy Center is so pleased with this common purchaser agreement which can serve as a framework for the field at large.
Learn more about the common purchaser agreement:
Elizabeth Mitchell, the CEO of PBGH, gave a preliminary review of the new framework at the Policy Center’s annual FORUM and provided a comprehensive overview at the Mom Congress “Saving and Supporting Moms” Congressional Briefing this month.
To review the full CMC, visit the PBGH resource page.
