Skip Navigation Links
Skip Navigation Links
September/October 2017Expand September/October 2017
July/August 2017Expand July/August 2017
May/June 2017Expand May/June 2017
March/April 2017Expand March/April 2017
January/February 2017Expand January/February 2017
November/December 2016Expand November/December 2016
September/October 2016Expand September/October 2016
July/August 2016Expand July/August 2016
May/June 2016Expand May/June 2016
March/April 2016Expand March/April 2016
January/February 2016Expand January/February 2016
November/December 2015Expand November/December 2015
September/October 2015Expand September/October 2015
July/August 2015Expand July/August 2015
May/June 2015Expand May/June 2015
March/April 2015Expand March/April 2015
January/February 2015Expand January/February 2015
ArchiveExpand Archive
Special Edition - EPRExpand Special Edition - EPR

 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 phanson@amchp.org.