TMaH
Transforming Maternal Health Model
The Transforming Maternal Health (TMaH) Model supports participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care. By addressing the physical, mental health, and social needs experienced during pregnancy, the model aims to improve outcomes and experiences for mothers and babies, while also reducing overall program expenditures.
Innovation
Integrates behavioral health, social drivers of health, and continuity of care in the postpartum period, including building a bridge between clinical and community-based care.
The Problem
The United States has one of the highest maternal mortality rates among high-income countries which disproportionately impacts Medicaid populations.
The Solution
The model supports state Medicaid agencies and holds them accountable to implement evidence-based strategies for expanding access to maternal care, while also integrating behavioral health, social drivers of health, and continuity of care in the postpartum period, including building a bridge between clinical and community-based care.
Expected Outcomes
The model aims to improve maternal and infant health outcomes, such as reduce rates of low-risk cesarean section (c-section), severe maternal morbidity (SMM), and incidence of low birthweight infants and improve overall care experiences for pregnant women.
Strategy
The model aligns with CMMI strategy to promote preventive care by increasing engagement in prenatal and post-partum care, expanding the perinatal health care team, and screening for and managing co-morbidities, as well as empowering patients by increasing their access to health information through technology and data, telehealth, and home monitoring.
Model Goals
- Improve maternal and infant health outcomes
- Reduce rates of low-risk cesarean section (c-section)
- Reduce severe maternal morbidity (SMM)
- Reduce incidence of low birthweight infants
- Improve overall care experiences for pregnant women
- Reduce overall program expenditures
Patient Eligibility
Medicaid populations experiencing pregnancy, childbirth, and the postpartum period.
- Medicaid beneficiary
- Pregnant or postpartum
Provider Eligibility
Participating state Medicaid agencies (SMAs).
- State Medicaid agency (SMA)
Care Categories
Maternal Health
CMS Benchmarks & Thresholds
operational
Performance Metrics
Low-risk cesarean section (c-section) rate
Reduction in rates of low-risk c-sections
Severe maternal morbidity (SMM)
Reduction in severe maternal morbidity
Low birthweight infants
Reduction in incidence of low birthweight infants
Detailed CMS benchmarks are being added for this model.
Operational Friction Summary
Where operational friction is highest for this model.
Early identification of pregnancy in Medicaid populations is critical to deploy behavioral health and social drivers of health (SDOH) interventions that prevent low birthweight and severe maternal morbidity.
TMaH requires integrating clinical care with community-based services (e.g., doulas, midwives) and behavioral health, which often operate on disparate or non-existent EHR platforms.
Financial accountability in TMaH is tied to specific clinical outcomes (c-section rates, SMM) that are heavily influenced by decisions made during the acute labor and delivery window.
Success in TMaH relies on shifting care toward high-value, community-based models (midwifery, doula care), which historically compete with or are siloed from traditional hospital-based OB practices.
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