NJ Tests a New Payment Model for Maternity Care

Morristown Minute

NJ FamilyCare’s new pilot program provides financial incentives to doctors who take on a comprehensive responsibility for the cost and quality of their patient’s maternity care.

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First Lady Tammy Murphy this week introduced a new NJ FamilyCare pilot program that aims to improve prenatal, labor and postpartum care in NJ.

NJ FamilyCare’s Perinatal Episode of Care program is a three-year pilot to test a new alternative payment model for prenatal, labor, and postpartum services statewide.

The program goal is to improve maternity care by encouraging NJ FamilyCare obstetrical providers to engage in all aspects of their patient’s care beyond direct obstetrical care, from pregnancy through the postpartum period, including emergency room visits and newborn pediatric care.

Clinicians who choose to participate in this new program are financially incentivized to take on comprehensive responsibility for the quality and cost of their patient’s care.

Additionally, participating providers will receive personalized feedback on their performance and take action to make improvements to their quality of care.

New Jersey is among one of the first states in the nation to develop this type of maternity care pilot program.

The NJ FamilyCare pilot program, launched in partnership with the New Jersey Department of Human Services, will bring us one step closer to reaching Nurture NJ’s goal of reducing our state’s maternal mortality by 50 percent over five years and eliminating racial disparities in birth outcomes,” said First Lady Tammy Murphy. “Coordinating and ensuring effective, quality perinatal care is vital to ensuring a safe and healthy pregnancy, labor and delivery for a mother and her baby. This groundbreaking program is a welcome addition to the many ongoing efforts we have in place to make New Jersey the safest, most equitable state in the nation to deliver and raise a baby.”
In New Jersey and across the nation we will not improve systemic inequities in maternal and child health care and outcomes by doing the same things we always have. This pilot program provides clinicians with additional data and financial incentives that will allow them to provide more innovative approaches in care,” Commissioner Adelman said. “We are excited about the providers participating in this program and we look forward to seeing the results of the pilot.”

Clinicians who volunteer to participate in this new pilot program are eligible to share in the savings recouped from more efficient perinatal care delivery. Additionally, the pilot program will include additional incentive payments for providers who hit key milestones on critical cost, quality, and other metrics.

NJ FamilyCare is New Jersey’s Medicaid and CHIP program, covering approximately 30,000 New Jersey births each year.

The addition of this new pilot program to the portfolio of NJ FamilyCare services came from major recommendations included in the Nurture NJ Maternal and Infant Health Strategic Plan – a roadmap that aims to make New Jersey the safest and most equitable place in the nation to deliver and raise a baby.

This new pilot program addresses a major recommendation in the Nurture NJ Maternal and Infant Health Strategic Plan – for DHS (Department of Human Services) to institute a perinatal episode of care (EOC) to ensure coordination of maternal services in the months prior to and after delivery. The goal is to link families to the tools and resources they need to carry out care plans recommended by their physicians.

Compared to other state Medicaid programs, New Jersey’s perinatal episode-of-care program is specifically meant to support high-quality maternity care with a focus on addressing health disparities in prenatal, labor, and postpartum care. Obstetrical practices who chose to participate in this voluntary pilot program will receive data on the quality of care their patients receive broken down by the NJ FamilyCare member’s race and ethnicity.

The launch of this new maternity care program comes after an extensive public engagement process following legislation signed into law by Governor Murphy in 2019. A multi-stakeholder Steering Committee, which included clinical obstetrical providers, hospital system operators, community doulas, and academic and community experts, met prior to the pilot program’s launch to discuss and solidify both the design and implementation of the new program.

Though strides have been made in health care accessibility and treatment for pregnant women and new mothers in New Jersey, there is no doubt we must continue to improve maternity care across the board,” said Senator Nellie Pou. “I was proud to be prime sponsor of legislation implementing a three-year perinatal episode of care pilot program in Medicaid, and want to thank Governor Murphy and First Lady Murphy for also remaining engaged on this issue. With a still significant number of New Jersey births being paid for by Medicaid, we must do all we can to improve the efficiency of services as well as the ability to boost incentives for the best care possible.”

This three-year pilot program will continue through June 2025. Initially more than a dozen NJ FamilyCare providers committed to participating in the new program – together, they provide maternity care for a third of NJ FamilyCare-covered births each year.

Participating maternity care centers for this three-year pilot period include:

  • AtlantiCare Physician Group – OB/GYN (Egg Harbor Township)
  • Axia Women’s Health (Voorhees)
  • Capital Health Regional Medical Center (Trenton) and Capital Health Medical Center (Hopewell Township)
  • Cooper University Health Care (Camden)
  • Hackensack University Medical Group (Hackensack)
  • Inspira Health Network Medical Group (Glassboro)
  • James Kusnierz PA (Irvington)
  • Kennedy Medical Group Practice (Jefferson Medical Group New Jersey) (Voorhees)
  • Lifeline Medical Associates, LLC (Florham Park)
  • St. Joseph’s Health (Paterson)
  • St. Peters University Hospital (New Brunswick)
  • The Combined Medical Group of RWJBarnabas Health and Rutgers Health (West Orange)
  • Tulip OBGYN, LLC (Paterson)
  • University Hospital (Newark)
  • Virtua Medical Group (Marlton)
  • Woman’s Comprehensive Healthcare of NJ (West Long Branch)

Click here for more information.

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