“The U.S. is experiencing a maternal health crisis: it has one of the highest maternal mortality rates among high-income nations; increasing rates of complications from pregnancy or childbirth; and persistent disparities in such outcomes.” That remarkable statement came from the US Department of Health and Human Services (HHS) and was echoed in a US Government Accountability Office (GAO) report issued last week, “Maternal Health: HHS Should Improve Assessment of Efforts to Address Worsening Outcomes.”

The GAO found that maternal mortality and other adverse outcomes associated with pregnancy or childbirth worsened significantly in 2020 – 2021 compared to 2018 – 2019, and disparities in outcomes persisted throughout the COVID-19 pandemic. The overall maternal mortality rate increased from 20.1 maternal deaths per 100,000 live births in 2019 to 32.9 in 2021. The maternal mortality rate increased more for Black and Hispanic women compared to white women during those years.

In the report, the GAO made several overarching recommendations, with which HHS concurred and noted that it plans to address. The question is, how will HHS do so? What are HHS and the Biden Administration doing to address this crisis, and is it enough? While the last question (is it enough?) may be impossible to answer, I’m bringing in my colleague Kayla Holgash to help address the first two.

When there is a major crisis, one of the first actions the federal government usually takes it to create an action plan. In June 2022, the White House released such a plan: a Blueprint for Addressing the Maternal Health Crisis. The blueprint lays out specific actions that the federal government will take to improve maternal health and outlines five priorities to address the maternal health crisis:

• Increase access to and coverage of comprehensive high-quality maternal health services, including behavioral health services
• Ensure those giving birth are heard and are decisionmakers in accountable systems of care
• Advance data collection, standardization, harmonization, transparency and research
• Expand and diversify the perinatal workforce
• Strengthen economic and social supports for people before, during and after pregnancy

The Centers for Medicare & Medicaid Services (CMS) has its own action plan that is aligned with these overall White House goals. CMS is focused on:

• Improving access to maternal care, including postpartum coverage, through Medicaid and the Children’s Health Insurance Program (CHIP)
• Improving data capabilities and reporting to identify disproportionate gaps in postpartum care
• Working with states to improve maternal and infant health policies
• Expanding access to community-based pregnancy and childbirth care such as doulas and community health workers
• Creating ways to better identify and support pregnant women and children’s social determinants of health

The White House, HHS and CMS have taken many steps to try to meet these goals. We highlight some of the major actions and initiatives here:

Initiatives

• Health Resources and Services Administration (HRSA) State Maternal Health Innovation (MHI) Program: HRSA’s MHI program provides funding to sites such as public health departments and universities to improve maternal health by establishing a maternal health task force in their state, improving the collection and use of state-level data on maternal mortality and severe maternal morbidity, and launching new maternal health service delivery activities such as expanding access to services during pregnancy and the postpartum period. The MHI program launched in September 2019 to fund nine entities (each awarded $1 million). This program currently has an open notice of funding opportunity that will close April 2, 2024.
• Maternal, Infant, and Early Childhood Home Visiting Program: The Affordable Care Act established this program to support home visits for expectant and new parents who live in communities that are at risk for poor maternal and child health outcomes. Congress extended authorization for the Program in December 2022.
• HEalth care Rewards to Achieve Improved OutcomES (HEROES): This program direct payments to individual “health accelerators” – such as nonprofits or care consortiums – to help them take responsibility for a geographic area with ownership on a key health outcome. Currently, a draft solicitation with funding is open for applications. The Advanced Research Projects Agency for Health (ARPA-H) is funding the project.
• Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundles: The AIM patient safety bundles, funded by HRSA, are compiled evidence-based practices with the goal of improving patient outcomes and care. The data collected through AIM bundles are used to address preventable severe maternal morbidity and mortality in the United States. HRSA has invested more than $5.5 million in AIM patient safety bundles to support the White House Blueprint goal of ensuring that those giving birth are heard and are decisionmakers in accountable systems of care.

CMS Innovation Center Model

• The Transforming Maternal Health (TMaH) Model: The CMS Innovation Center announced a new model on December 15, 2023, that will support participating state Medicaid agencies in developing new holistic approaches to maternal care. The model’s stated goal is to reduce disparities in access and treatment. The TMaH model will focus on three pillars:
  • Access to care, infrastructure and workforce capacity
  • Quality improvement and safety
  • Whole-person care delivery

CMS will release a notice of funding opportunity for state Medicaid agencies in spring 2024. Applications will be due in summer 2024. The model is projected to run for 10 years.

Task Forces and Other Resources

• The Task Force on Maternal Health: This task force was launched by the Office of Women’s Health at HHS and is co-chaired by Admiral Rachel Levine, MD, HHS assistant secretary for Health, and Miriam E. Delphin-Rittmon, PhD, assistant secretary for mental health and substance use. The stated purpose of the task force is to “identify, evaluate, and make recommendations to coordinate and improve activities related to addressing maternal mental health conditions and co-occurring substance use disorders.”
• CMS Guidance Document, “Increasing Access, Quality, and Equity in Postpartum Care in Medicaid and CHIP: A Toolkit for State Medicaid and CHIP Agencies”: This August 2023 toolkit provides information to help states maximize the use of existing authorities to increase postpartum care access, quality and equity for people enrolled in Medicaid and CHIP.
• Pregnancy Risk Assessment Monitoring System (PRAMS) data: This system is a joint research project between state, territorial or local health departments and the Centers for Disease Control and Prevention that speeds up the process of collecting data on maternal health and outcomes. PRAMS data are used by researchers to investigate emerging issues in the field of reproductive health, and by local, state and federal health officials to plan and review programs and policies aimed at reducing health problems among mothers and infants.
• Implementing a Maternal health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative: This initiative, operated by the National Institutes of Health (NIH), aims to reduce maternal deaths and improve health for women before, during and after giving birth. The NIH has awarded $24 million to establish the Maternal Health Research Centers of Excellence in order to develop and evaluate innovative approaches to reduce maternal health disparities.
• Agency for Healthcare Research and Quality actions: The agency has released several resources and reports, including:

These are just some of the actions the Biden Administration has taken and the resources and funding opportunities available for states, providers, patients and other stakeholders. However, given the extent of the problem and the existing disparities in maternal care and outcomes, these steps are just the beginning, and this issue will continue to be a major priority for the Administration in the months ahead.

Until next week, this is Jeffrey (and Kayla) saying, enjoy reading regs with your eggs.

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