The Kansas Department of Health and Environment, Division of Health Care Finance (KDHE) is the single state Medicaid agency. The TMaH Model will be implemented in a sub-state region of 30 mainly rural and frontier counties in southwest/central Kansas. Thirty-one counties in northwest/central Kansas will serve as the comparison region. Kansas has yet to adopt Medicaid expansion, but KDHE has continued efforts to expand coverage and benefits for maternal health to improve outcomes that lag behind other states by extending KanCare coverage to 12 months postpartum and covering doula services. These efforts showcase KDHE’s experience and efforts in addressing maternal health-related challenges, making it poised to participate in the TMaH Model. The strategic timeline aligns with previous and ongoing initiatives and will continue this momentum to make a once-in-a-generation shift in service provision and provider payments to positively impact maternal health for future generations of Kansans. The purpose of participating includes the new payment model being the catalyst that integrates and aligns the various initiatives conducted across the state into a uniform approach to achieve the goals of the TMaH Model, improve maternal outcomes in Kansas, and offer a financial path forward for rural and other providers. The new payment model will enable the state to move away from a bundled, global obstetric reimbursement strategy and develop a model that is more equitable to providers and rewards practitioner performance for high-quality care and outcomes instead of incentivizing utilization.
Outcomes include improving data infrastructure; developing the payment model; supporting the implementation of AIM safety bundles; supporting “birthing friendly” hospital designation; promoting shared decision-making; enhancing screenings for HRSNs, mental health, and SUD; advancing health equity; growing the perinatal community health worker (CHW) workforce; and increasing use of home visits, mobile clinics, and telehealth including home monitoring in a sustainable way that involves partner providers, care delivery locations, and organizations. The TMaH Model will help close service gaps in southwest/central Kansas by building from the existing care offered by providers; supporting and restructuring partnerships across the region including MCOs, providers, and members; providing increased access to telehealth/home monitoring; supporting doula, midwife, and CHW workforce enhancements and retention; and helping to reduce disparities which will lead to achieving the model pillar elements and the TMaH goals. Achieving the model elements will also advance and align the maternal health policy priorities outlined in the state’s Healthy Kansans 2030 initiative (patterned after the national Healthy People 2030 initiative).
Project goals:
• By end of Year 2, enhance data infrastructure including linking claims data and birth certificates to vital records and performing data-matching across social service and benefit programs and Medicaid to measure and address cross-program enrollment gaps.
• By end of Year 3, implement the new payment model with CMS Technical Assistance.
• By end of Year 4, implement activities to meet the goals of the TMaH Model namely reduced rates of low-risk c-sections, reduced incidence of severe maternal morbidity, reduced rates of low-birthweight infants, improved experience of perinatal care, and reduced Medicaid and CHIP program expenditures for maternity and infant care.
• By end of Year 4, grow the perinatal CHW workforce, and increase the use of home visits, mobile clinics, and telehealth including home monitoring.
The total budget is $12,370,219. Funds will be used for nine full-time positions to implement the model, travel, supplies, contractor costs for assistance with rate setting for the new payment model and data infrastructure, and Provider Infrastructure Payments (in Year 3).
