Quality Of Maternal And Perinatal Health Care In Medicaid .
Quality of Maternal andPerinatal Health Care inMedicaid and CHIP: Findingsfrom the 2019 Maternity CoreSetDecember 2020Chart Pack This chart pack is a product of the Technical Assistance and Analytic Support for the Medicaid and CHIPQuality Measurement and Improvement Program, sponsored by the Center for Medicaid and CHIP Services.The technical assistance team is led by Mathematica, in collaboration with the National Committee forQuality Assurance, Center for Health Care Strategies, AcademyHealth, and Aurrera Health Group.
Table of ContentsABOUT THE 2019 MATERNITY CORE SET . . 4OVERVIEW OF STATE REPORTING OF THE 2019 MATERNITY CORE SET . . . 5Number of Maternity Core Set Measures Reported by States, FFY 2019. . . .6Number of States Reporting the Maternity Core Set Measures, FFY 2019. . . 7Number of States Reporting the Maternity Core Set Measures, FFY 2017–FFY 2019 .8Geographic Variation in the Number of Maternity Core Set Measures Reported by States,FFY 2019 . . .10FREQUENTLY REPORTED MATERNITY CORE SET MEASURES, FFY 2019 .11Populations Included in Frequently Reported Maternity Core Set Measures for FFY 201912Median Performance Rates on Frequently Reported Maternity Core Set Measures, FFY2019 . . . 13Well-Child Visits in the First 15 Months of Life .14Prenatal and Postpartum Care: Timeliness of Prenatal Care . .16Prenatal and Postpartum Care: Postpartum Care . . . .18Live Births Weighing Less Than 2,500 Grams . . .20Pediatric Central Line-Associated Blood Stream Infections . 22Contraceptive Care: Postpartum Women Ages 15 to 20 . . . .24Contraceptive Care: Postpartum Women Ages 21 to 44 . . . .29Contraceptive Care: All Women Ages 15 to 20 . . . .342
Table of Contents (continued)TRENDS IN STATE PERFORMANCE, FFY 2017–2019 .37Trends in State Performance, FFY 2017–2019: Introduction . 38Trends in State Performance, FFY 2017–2019 . .39REFERENCE TABLES AND ADDITIONAL RESOURCES . .413Overview of State Reporting of the Maternity Core Set Measures, FFY 2019 . . 42Performance Rates on Frequently Reported Maternity Core Set Measures, FFY 2019. .44Trends in Performance Rates on Frequently Reported Maternity Core Set Measures, FFY2017–2019 . . . . . . . . . . . . .46Acronyms .47Additional Resources 48
About the 2019 Core Set of Maternal and PerinatalHealth Measures (Maternity Core Set)As the largest payer for maternity care in the United States, covering 42 percent of all births,Medicaid has an important role to play in improving maternal and perinatal health outcomes.1Despite improvements in access to coverage and care, the rate of births reported as preterm orlow birth weight among women in Medicaid is higher than the rate for those who are privatelyinsured.2 The health of a child is affected by a mother’s health and the care she receives duringpregnancy. When women access the health care system for maternity care, an opportunity ispresented to promote services and behaviors to optimize their health and the health of theirchildren.As the U.S. Department of Health & Human Services agency responsible for ensuring qualityhealth care coverage for Medicaid and Children’s Health Insurance Program (CHIP)beneficiaries, the Centers for Medicare & Medicaid Services (CMS) plays a key role in promotingquality maternal and perinatal health care for children and adults in Medicaid and CHIP. Tosupport maternal and perinatal health-focused efforts, CMS identified a core set of 12 measuresfor voluntary reporting by state Medicaid and CHIP agencies (Maternity Core Set), which includes8 measures from CMS’s Child Core Set and 4 measures from the Adult Core Set. CMS uses thisMaternity Core Set to measure and assess progress on improving maternal and perinatal healthcare in Medicaid and CHIP.This Chart Pack summarizes state reporting on the quality of maternal and perinatal health carecovered by Medicaid and CHIP during FFY 2019, which generally covers care delivered incalendar year 2018. The Chart Pack includes analysis of state performance on 8 publiclyreported measures. For a measure to be publicly reported, data must be provided to CMS by atleast 25 states and meet CMS standards for data quality.More information about CMS’s efforts to improve maternal and infant health care quality isavailable at index.html.1Dataon births covered by Medicaid and CHIP is available at df.2 ownloads/CIB-07-18-2014.pdf412measures address keyaspects of health careaccess and qualityrelated to maternal andperinatal healthcovered by Medicaidand CHIPMore information about the Child CoreSet is available easures/index.html.More information about the Adult CoreSet is available res/index.html.
OVERVIEW OF STATE REPORTINGOF THE 2019 MATERNITYCORE SET5
Number of Maternity Core Set Measures Reported by States,FFY 2019States reported amedian of6Maternity CoreSet measures for FFY2019Sources: Mathematica analysis of MACProreports for the FFY 2019 reporting cycle asof May 31, 2020 and Centers for DiseaseControl and Prevention Wide-rangingONline Data for Epidemiologic Research(CDC WONDER) for calendar year 2018.Notes: The term “states” includes the 50states and the District of Columbia. The2019 Maternity Core Set includes 12measures. This chart includes all theMaternity Core Set measures for the FFY2019 reporting cycle, except the CLABSImeasure, which is obtained from CDC’sNational Healthcare Safety Network, anduses a different statistic.Unless otherwise specified, states usedCore Set specifications to calculate themeasures. Some states calculatedmeasures using “other specifications.”Measures were denoted as using “otherspecifications” when the state deviatedsubstantially from the Core Setspecifications, such as using alternate datasources, different populations, or othermethodologies.6
Number of States Reporting the Maternity Core Set Measures,FFY 201951states voluntarilyreported at least oneMaternity Core Setmeasure for FFY 2019Sources: Mathematica analysis of MACProreports for the FFY 2019 reporting cycle asof May 31, 2020 and Centers for DiseaseControl and Prevention Wide-rangingONline Data for Epidemiologic Research(CDC WONDER) for calendar year 2018.Notes: The term “states” includes the 50states and the District of Columbia. The2019 Maternity Core Set includes 12measures. This chart includes all theMaternity Core Set measures for the FFY2019 reporting cycle, except the CLABSImeasure, which is obtained from CDC’sNational Healthcare Safety Network, anduses a different statistic.Unless otherwise specified, states usedCore Set specifications to calculate themeasures. Some states calculatedmeasures using “other specifications.”Measures were denoted as using “otherspecifications” when the state deviatedsubstantially from the Core Setspecifications, such as using alternate datasources, different populations, or othermethodologies.7
Number of States Reporting the Maternity Core Set Measures,FFY 2017–2019State reporting remainedconsistent or increased for8of the 12measures includedin the Maternity CoreSets for all three yearsNote: For states that did not report theLive Births Weighing Less Than 2,500Grams measure using Child Core Setspecifications for FFY 2019, CMScalculated the measure using birthcertificate data submitted by states andcompiled by the National Center forHealth Statistics (NCHS) in CDCWONDER. States that reported themeasure using Core Set specificationscould also elect to use CDC WONDER.8
Number of States Reporting the Maternity Core Set Measures,FFY 2017–2019 (continued)Sources: Mathematica analysis of FFY2017–FFY 2019 MACPro reports and theCenters for Disease Control andPrevention Wide-ranging ONline Data forEpidemiologic Research (CDC WONDER)for calendar year 2018.Notes: The term “states” includes the 50states and the District of Columbia. The2019 Maternity Core Set includes 12measures. This chart includes all theMaternity Core Set measures for the FFY2019 reporting cycle, except the CLABSImeasure, which is obtained from CDC’sNational Healthcare Safety Network, anduses a different statistic.Unless otherwise specified, states usedCore Set specifications to calculate themeasures. Some states calculated CoreSet measures using “other specifications.”Measures were denoted as using “otherspecifications” when the state deviatedsubstantially from the Core Setspecifications, such as using alternate datasources, different populations, or othermethodologies.NA not applicable; measure not includedin the Core Set for the reporting period.9
Geographic Variation in the Number of Maternity Core SetMeasures Reported by States, FFY 201913statesreported at least 9Maternity Core Setmeasures for FFY 2019Sources: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020 and Centers for DiseaseControl and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) for calendar year 2018.Notes: The term “states” includes the 50 states and the District of Columbia. The 2019 Maternity Core Set includes 12 measures.This chart includes all the Maternity Core Set measures for the FFY 2019 reporting cycle, except the CLABSI measure,which is obtained from CDC’s National Healthcare Safety Network.10
Frequently Reported Maternity Core Set Measures,FFY 2019Eight Maternity Core Set measures were available for analysis for FFY 2019. Thesemeasures were reported by at least 25 states for the Child or Adult Core Set for FFY2019 and met CMS standards for data quality. 11Well-Child Visits in the First 15 Months of Life (Child Core Set)Prenatal and Postpartum Care: Timeliness of Prenatal Care (Child Core Set)Prenatal and Postpartum Care: Postpartum Care (Adult Core Set)Live Births Weighing Less Than 2,500 Grams (Child Core Set)Pediatric Central Line-Associated Blood Stream Infections (Child Core Set)Contraceptive Care: Postpartum Women Ages 15 to 20 (Child Core Set)Contraceptive Care: Postpartum Women Ages 21 to 44 (Adult Core Set)Contraceptive Care: All Women Ages 15 to 20 (Child Core Set)
Populations Included in Frequently Reported Maternity Core Set Measures forFFY 2019Sources: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020 and Centers for DiseaseControl and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) for calendar year 2018.Notes: This chart includes measures that were reported by at least 25 states for FFY 2019 and that met CMS standards for dataquality. This chart includes all the Maternity Core Set measures for the FFY 2019 reporting cycle, except the CLABSImeasure, which is obtained from CDC’s National Healthcare Safety Network, and uses a different statistic. For 39 states, theLive Births Weighing Less than 2,500 Grams measure was calculated by CMS using birth certificate data submitted by statesand compiled by the National Center for Health Statistics in CDC WONDER. Some states may include CHIP beneficiaries inthese data.“Dual Eligibles” refers to beneficiaries dually enrolled in both Medicare and Medicaid. States can include different populationsfor Child and Adult Core Set reporting.12
Median Performance Rates on Frequently Reported Maternity Core SetMeasures, FFY 2019Sources: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020 and Centers for Disease Controland Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) for calendar year 2018.Notes: This chart includes measures that were reported by at least 25 states for FFY 2019 and that met CMS standards for dataquality. This chart excludes the CLABSI measure, which is obtained from CDC’s National Healthcare Safety Network, and usesa different statistic.*Lower rates are better for this measure.13
Well-Child Visits in the First 15 Months of Life (Child Core Set)The American Academy of Pediatrics and Bright Futures recommend nine well-care visitsby the time children turn 15 months of age. These visits should include a health history,physical examination, immunizations, vision and hearing screening, developmental/behavioral assessment, an oral health risk assessment, as well as parenting education ona wide range of topics. In the Child Core Set, state performance is measured as thepercentage of children who received six or more visits by 15 months.Percentage of Children Receiving Six or More Well-Child Visits in the First 15 Months ofLife (W15-CH), FFY 2019 (n 48 states)Source: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020.Notes: This measure shows the percentage of children who turned 15 months old during the measurement year and who had thefollowing number of well-child visits with a primary care practitioner (PCP) during their first 15 months of life: 0, 1, 2, 3, 4, 5,and 6 or more visits. This chart shows state reporting for the percentage with 6 or more well-child visits. When a statereported separate rates for its Medicaid and CHIP populations, the rate for the larger measure-eligible population was used.14A median of64percentof children received sixor more well-child visitsin the first 15 monthsof life (48 states)
Well-Child Visits in the First 15 Months of Life (Child Core Set) (continued)Geographic Variation in the Percentage of Children Receiving Six or More Well-Child Visits in the First 15 Months of Life(W15-CH), FFY 2019 (n 48 states)Source: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020.Note:When a state reported separate rates for its Medicaid and CHIP populations, the rate for the larger measure-eligiblepopulation was used.15
Prenatal and Postpartum Care: Timeliness of Prenatal Care(Child Core Set)Initiation of prenatal care during the first trimester of pregnancy facilitates acomprehensive assessment of a woman’s health history, pregnancy risk, and healthknowledge. Early screening and referrals for specialized care can prevent pregnancycomplications resulting from pre-existing health conditions or promote access torecommended care. The prenatal care measure assesses how often pregnant womenreceived timely prenatal care (during the first trimester or within 42 days of Medicaid orCHIP enrollment).Percentage of Women Delivering a Live Birth with a Prenatal Care Visit in the First Trimesteror within 42 Days of Enrollment in Medicaid or CHIP (PPC-CH), FFY 2019 (n 42 states)Source: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020.Notes: This measure shows the percentage of deliveries of live births on or between November 6 of the year prior to themeasurement year and November 5 of the measurement year that had a prenatal care visit in the first trimester, on theenrollment start date, or within 42 days of enrollment in Medicaid or CHIP. When a state reported separate rates for itsMedicaid and CHIP populations, the rate for the larger measure-eligible population was used.16A median of81percentof pregnant womenhad a prenatal carevisit in the firsttrimester or within 42days of Medicaid orCHIP enrollment (42states)
Prenatal and Postpartum Care: Timeliness of Prenatal Care (Child Core Set)(continued)Geographic Variation in the Percentage of Women Delivering a Live Birth with a Prenatal Care Visit in the First Trimesteror within 42 Days of Medicaid or CHIP Enrollment (PPC-CH), FFY 2019 (n 42 states)Source: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020.Note:When a state reported separate rates for its Medicaid and CHIP populations, the rate for the larger measure-eligiblepopulation was used.17
Prenatal and Postpartum Care: Postpartum Care(Adult Core Set)Postpartum visits provide an opportunity to assess women’s physical recovery frompregnancy and childbirth, and to address chronic health conditions (such as diabetesand hypertension), mental health status (including postpartum depression), and familyplanning (including contraception and inter-conception counseling). The postpartum caremeasure assesses how often women delivering a live birth received timely postpartumcare (between 21 and 56 days after delivery).Percentage of Women Delivering a Live Birth who had a Postpartum Care Visit on orBetween 21 and 56 Days after Delivery (PPC-AD), FFY 2019 (n 39 states)Source: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020.Note:This measure shows the percentage of deliveries of live births on or between November 6 of the year prior to themeasurement year and November 5 of the measurement year that had a postpartum visit on or between 21 and 56 daysafter delivery.18A median of61percentof women delivering alive birth had apostpartum care visiton or between 21 and56 days after delivery(39 states)
Prenatal and Postpartum Care: Postpartum Care (Adult Core Set) (continued)Geographic Variation in the Percentage of Women Delivering a Live Birth who had a Postpartum Care Visit on orBetween 21 and 56 Days after Delivery (PPC-AD), FFY 2019 (n 39 states)Source: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020.19
Live Births Weighing Less Than 2,500 Grams (Child Core Set)An infant’s birth weight is a common measure of infant and maternal health and wellbeing. Infants weighing less than 2,500 grams at birth may experience serious andcostly health problems and developmental delays. Pregnant women are at higher risk ofa low birth weight baby if they have chronic health conditions (such as high bloodpressure or diabetes), low weight gain during pregnancy, high stress levels, or high-riskbehaviors (such as drinking alcohol, smoking cigarettes, or using drugs).Percentage of Live Births Weighing Less Than 2,500 Grams (LBW-CH), FFY 2019(n 51 states) [Lower rates are better for this measure]Sources: Mathematica analysis of MACPro reports for the FFY 2019 reporting cycle as of May 31, 2020 and National Vital StatisticsSystem Natality data obtained through Centers for Disease Control and Prevention Wide-ranging ONline Data forEpidemiologic Research (CDC WONDER) for calendar year 2018.Notes: This measure shows the percentage of live births that weighed less than 2,500 grams at birth. For FFY 2019, the data sourceused for some states changed; CMS calculated rates using CDC WONDER data for states that did not report the measure inMACPro using Child Core Set specifications as well as states that reported using Child Core Set specifications and opted touse the CDC WONDER rate. These rates may not be comparable with rates reported in previous years. The term “states”includes the 50 states and the District of Columbia. When a state reported separate rates for its Medicaid and CHIPpopulations, the rate for the larger measure-eligible population was used.20A median of9.5percent of live birthsfinanced by Medicaidor CHIP weighed lessthan 2,500 grams atbirth (51 states)
Live Births Weighing Less Than 2,500 Grams (Child Core Set) (continued)Geographic Variation in the Percentage of Live Births Weighing Less Than 2,500 Grams (LBW-CH),
Maternity Core Set to measure and assess progress on improving maternal and perinatal health care in Medicaid and CHIP . This Chart Pack summarizes state reporting on the quality of maternal and perinatal health care covered by Medicaid and CHIP duri
South Asia have the highest maternal mortality, contrib-uting up to 86% maternal mortality globally [1]. Tanzania is among the sub-Saharan countries with the highest maternal mortality. The maternal mortality ratio in Tanzania is as high as 556 maternal death in every 100,000 live births [2]. It has been reported that the most leading causes of
The Nigerian Federal Ministry of Health (FMOH) adopted the Maternal and Perinatal Death Surveillance and Response policy and guidelines in 2016. Since other maternal and perinatal death audit models had been implemented in the country, the . ASSESSMENT OF MATERNAL AND PERINATAL DEATH SURVEILLANCE AND RESPONSE IMPLEMENTATION IN NIGERIA 7.
counting maternal deaths. National statistics on maternal mortality, therefore, vary consid-erably from maternal death estimates: Official government figures for 2008 showed a total of 5,670 maternal deaths in Latin America, substantially fewer than the 9,075 estimated by the United Nations Maternal Mortality
Work on maternal health services has begun with a rapid appraisal of maternal health care in each of the participating countries. Maternal health services and the improvement of maternal mortality are internationally acknowledged as priority issues for health services development. Maternal health services are also useful as a health system probe.
situation of maternal mortality is still worrying. Sixteen out of the forty-eight countries in the region have very high maternal mortality ranging between 500 to 999 maternal deaths per 100,000 live births in 2017 (WHO et al.2019). The current estimates on maternal mortality show that the maternal mortality ratio, an
B. Maternal Mortality C. Perinatal and Neonatal Mortality I. PRIMARY PREVENTION OF MATERNAL, PERINATAL AND NEONATAL DEATHS . 1991, to conduct a rapid assessment of the maternal and neonatal health situation. The assessment included an extensive literature review; documentation of the PVO, Ministry of Public . their current health programs;
period 2006-2018, suicide accounted for 30 maternal deaths and Māori women are 3.35 times more likely to die by suicide according to the 2021 report from the Perinatal and Maternal Mortality Review Committee (PMMRC). The report highlights that even though the rates of maternal death in Aotearoa are
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