There’s long been talk about the need to improve outcomes for New Jersey mothers and their babies. Now we’re seeing that talk turn into action. In the past 20 months, new laws and initiatives have advanced to improve maternal-child health, and to address troubling racial inequities.
Here are just some of the new laws:
- Medicaid coverage, pending federal approval, extended from 60 to 180 days after birth for women who would otherwise lose thier coverage.
- Medicaid coverage of certified doulas.
- Medicaid coverage of Centering Pregnancy Programs, which provide group prenatal programs to support women.
- Elimination of payment for elective, non-medically necessary early deliveries by Medicaid and the State Health Benefits Program.
- Required use of the Perinatal Risk Assessment (PRA) to help Medicaid providers and plans connect women to support services.
But we are by no means at the end of our work — we’re closer to the beginning. We now have new opportunities and challenges to see policy changes through to create real change in the lives of mothers and babies. I’m calling on our Quality Institute members to help advance the promise of these new initiatives, which focus on three areas.
Patient Needs and Supports
New Jersey is now providing Medicaid coverage of new programs to support mothers. But these won’t help if providers and women don’t know about them. At the Quality Institute, we’re especially supportive of requiring providers and plans to use the Perinatal Risk Assessment (“PRA”), a uniform information collection tool to identify women who would benefit from support such as the Nurse Family Partnership, a Quality Institute member and proven visiting nurse model; assigned a doula; or recommended to join a prenatal group visit program such as Strong Start. Medicaid now covers these programs and we need providers to guide women to them along with other supports, such as food and housing, or other resources. The law requires that Medicaid managed care plans, doctors, clinics, and hospitals use the PRA, which means we also can collect data to determine which programs are most needed. We also must track participation and outcomes.
At the Quality Institute, we have long advocated for public transparency on maternal health measures at the hospital level. Every New Jersey hospital with a labor and delivery unit now reports to Leapfrog on early elective deliveries; Cesarean rates for first time, head-down single births; and episiotomies. We need consumers, employer-purchasers, and health plans to use this data when making decisions — whether about where to have a baby, which health plan to select, or which hospitals to include in a provider network. Doctors and nurses in many New Jersey hospitals have embraced quality improvement over the past few years by actively participating in the New Jersey Perinatal Quality Collaborative along with their own internal quality improvement efforts. Their efforts should be celebrated as already we are seeing improvement in some of these quality measures.
At the Quality Institute, we’ve long argued that the State should leverage the power of its purse strings to drive quality. The State pays for about half of the births in New Jersey through Medicaid and the State Health Benefits Program combined. For the first time, through recent legislation, the state will stop paying for early elective deliveries, which are births induced prior to 39 weeks for no medical reason. And right now, at the Quality Institute, our Medicaid Policy Center is working with the state to bring together people involved in maternal health to develop a pilot Episode of Care payment program, which would reward providers for quality improvements and lower costs, such as those in the Neonatal Intensive Care Unit. Part of our work with the state will be to educate consumers and providers so people in all corners will understand these changes and will benefit as we align payment to outcomes.
Yes, we are asking a great deal from the Department of Health and Office of Medicaid and there is tremendous work ahead. And providers and hospitals face many changes as we move forward. But other states have achieved better outcomes for their mothers and babies and New Jersey can, too. The work of creating a healthier and more equitable state deserves the best from all of us. At the Quality Institute, we look forward to working with our state leaders, and all of you, as we transform care for New Jersey mothers and babies.