Redesigning Maternity Care for the COVID-19 Era and Beyond

The maternity care model in the United States is beset with several challenges, which include dismal maternal health outcomes, rising maternity costs and persistent rural, racial, and ethnic disparities. At the same time, the U.S. maternity care system has seen limited structural changes over the years. For example, the conventional prenatal care schedule predates World War II. In 2017, just 0.1% of prenatal visits were conducted via telehealth and fewer than 2% of American women gave birth outside of a traditional hospital setting.

In an attempt to address these challenges, health care leaders have turned to care and payment reforms. Early evidence on maternity care alternative payment models (APMs) from Tennessee, Ohio and Arkansas have shown APMs’ ability to reduce health care expenditures and improve health care quality. The onset of the COVID-19 pandemic and associated public health emergency have renewed focus on the need to reform maternity care models, building on the success of these earlier value-based care reforms.

The COVID-19 pandemic has, at least for the time being, upended health care norms and transformed health care, including for pregnancy care. For example, social distancing measures imposed by COVID-19 facilitated the implementation of new care delivery models with a hybrid of in-person and virtual visits instead of the standard 12-14 in-person prenatal visits. These care delivery changes have been supported by and accompanied by several policy changes. Although some of these changes will terminate with the end of the public health emergency, others, such as greater use of virtual care, are likely to extend beyond the pandemic. Alongside changes in the health care delivery landscape is a renewed focus on health disparities and health equity, stemming from the disproportionate impact of COVID-19 on communities of color, which exacerbated existing disparities.

This issue brief captures key Medicaid and commercial payer policy changes made to date in response to the pandemic, examines the preliminary impact of COVID-era policy changes, and makes policy recommendations for states and commercial payers to consider to help sustain access to care, improve outcomes and reduce disparities, and encourage smarter spending during the pandemic and beyond.