Maternity Episode Payment Model Online Resource Bank
Maternity care cost varies significantly by payer (commercial or Medicaid), by type of birth (vaginal or cesarean section), and by setting (hospital or birth center). Prenatal care, labor and birth, and postpartum care are often paid for and delivered as three distinct periods when, in reality, they are all three phases of one episode in a woman’s life. To incentivize coordination across the practitioners and settings where the full spectrum of maternity services are provided, episode payment can be used with the goals of improving patient care, increasing coordination across services and providers, and lowering health care costs.
To accelerate the movement toward maternity episode payment models, the LAN developed recommendations for maternity episode design in the Clinical Episode Payment White Paper. It also operated the Maternity Multi-Stakeholder Action Collaborative, or “MAC” from December 2016 through September 2017. The MAC’s goal was to accelerate the adoption of maternity care alternative payment models that improve outcomes and care experience for mothers and babies, and reduce the cost of care. The operating framework for this was the LAN’s Clinical Episode Payment White Paper maternity recommendations. Over the 10 months that the MAC was operating, there were nine virtual meetings held to provide learning and expertise on topics related to design and implementation of maternity episodes, including making the business case, selecting and using quality measures, determining services and population, developing the episode budget, working with Medicaid Managed Care organizations, and others.
The LAN developed an online resource bank – built on the Clinical Episode Payment work group design elements “wheel” – which provides a one-stop-shop for all the information and resources, including:
- The LAN CEP white paper maternity recommendations
- Slides, e-books, and summaries from all of the MAC virtual meetings.
We encourage you to use this information and to keep the LAN informed of your work in designing and implementing maternity APMs.
Maternity Measures Buying Value Tool
This file is a pdf for viewing.
To receive an active file, please e-mail us at
HCP-LAN Support
Payers | 
Providers
Purchasers
Community Organizations
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
