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Title V Technical Assistance Meeting

 NAMD/AMCHP Support State-to-State Learning on the Overuse of C-Sections among Low-Risk, First-Time Mothers

lindsey.jpgBy Lindsey Browning, MPP
Policy Analyst, NAMD

As a major payer and market force in MCH, Medicaid agencies are essential to innovations that improve the health of pregnant women and their children. Recent efforts to curb early elective deliveries demonstrate the potential impact of these reforms. With the ongoing movement to pay for value rather than volume in Medicaid, states are identifying new ways to address birth outcomes and build on existing initiatives. Some states have identified an opportunity to address the overuse of cesarean-sections for low-risk births among first time mothers (low-risk, primary C-sections) to drive value in Medicaid. States are targeting this in order to address the adverse outcomes that result from non-medically indicated C-sections, as well as the significant cost implications of its overuse.

To support states that are working on this issue, the National Association of Medicaid Directors (NAMD) and AMCHP created a virtual learning collaborative last December to facilitate state-to-state learning around low-risk, primary C-sections. Medicaid agency officials that were interested in this issue elected to participate in the series of virtual discussions. Many participants also brought sister state agency representatives to the table, including individuals from public health departments and Title V MCH programs. States did so in recognition that effective policy solutions often hinge on multiagency collaboration.

Over a five-month period, participants explored policy approaches to address low-risk, primary C-sections and the many complex factors that drive the unnecessary use of this service. The discussion recognized that no one-size-fits-all solution exists. Rather, states explored opportunities for sharing learning, including around four key elements of efforts to address low-risk, primary C-sections:

  • Stakeholder engagement in shaping policy initiatives and sustaining them
  • The role of data and quality metrics to promote transparency and inform other policy approaches
  • Payment models to incentivize the use of vaginal birth and discourage overuse of low-risk C-sections among first-time mothers

Participants also explored the importance of interagency partnership within each key element of their policy efforts. For example, states discussed how interagency partnership can effectively support stakeholder engagement; each agency can involve key groups with whom it has a strong relationship, such as clinicians, hospitals, Title V programs and consumer-focused organizations, like the March of Dimes. In another instance, states explored the role of vital records data in reducing the excessive use of low-risk C-sections, and how interagency partnership is necessary for its use. To learn more about this project please contact Piia Hanson at