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Date(s) - Thursday, May 04, 2017, 1:00 PM - 2:00 PM

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Thursday, May 4, 2017

1:00PM – 2:00PM ET

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MAC Session 4: Setting the Patient Population

The purpose of this meeting is to harvest knowledge about critical considerations for defining the patient population for a maternity episode payment model or other maternity APM.

Session Materials

  • Agenda
  • Meeting Presentation
  • Meeting Materials
    • Comparison of Patient Populations within Existing Maternity Care Initiatives
    • Additional Information on Existing Maternity Care Initiatives
    • Arkansas Health Care Payment Improvement Initiatives
    • Community Health Choice of Texas Maternity and Newborn Care Payment Pilot
    • Geisinger Health System’s Perinatal ProvenCare Program
    • Integrated Healthcare Association’s Bundled Episode Payment – Pregnancy and Delivery (Mother Only)
    • New York State Department of Health’s Delivery System Reform Incentive Payment Program (DSRIP) Maternity Care Bundle
    • Tennessee Division of Health Care Finance & Administration’s Perinatal Episode of Care

Session Goals

  • Introduce the considerations for determining what population of pregnant women will be included in an episode, as well as the considerations for including or not including the baby. Topics to be discussed will include the following:
    • Which pregnant women are most likely to experience a full episode-of-care (which may be affected by the insurance status)
    • Whether high-risk pregnant women should be included (and what the definition of high-risk pregnant women might be)
    • Whether the baby should be included in the episode
    • Stability of patient’s insurance status – especially for Medicaid populations
  • Ask questions of and interact with each other and an expert discussant from an organization that decided to include newborns and high-risk women in the episode:
    • Learn why this decision was made
    • Learn from the challenges this health plan faced, including linking the mother and baby in the data and setting episode budgets for high-risk women.
  • Identify leading and promising practices for further action
  • Discuss action steps that may be taken within your organizations
  • Solicit participant feedback and any specific requests for future meetings

Expert Discussants

  • Karen Love, Community Health Choice, Texas


To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.


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