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Accountable care is well-positioned to make a significant impact on the health care needs of women. When it comes to the state of women’s health in the United States today, there is much to be desired. Evidence shows troubling trends to that end: the United States, among high-income nations, has the worst maternal health outcomes; additionally, women are more likely to report delaying preventive care, be caregivers, and develop chronic conditions like dementia than men. Among women, there are also deep inequities in access, quality, and outcomes by race, ethnicity, geography, and economic status. 

These disparities pose unique health challenges for women that must be addressed using targeted approaches such as improving access to preventative care and enhancing maternal health supports. On October 17, Accountable for Health, the National Partnership for Women & Families (NPWF), and United States of Care (USofCare) co-hosted a virtual Congressional briefing, “Advancing Women’s Health & Patient-First Care Through Innovation & Payment Reform,” making the compelling case for  how accountable care can improve  outcomes, particularly in women’s health (briefing slides are available here). Invited speakers included Dr. Kristin Oaks, Lisa Hunter, and Dr. Carol Sakala, each providing a unique perspective on how accountable care has improved health outcomes and patient experiences for women. 

Putting Quality Over Quantity in Women’s Health – A Dementia Care Model

Following Dr. Oaks, Lisa Hunter, from USofCare, discussed the policy side of accountable care. USofCare’s listening research shows that nearly two out of three people believe the fee-for-service system doesn’t work because it is fragmented, lacks coordination, fosters an overreliance on medication rather than prevention, and creates long appointment wait times. Instead, people desire a “patient-first care” system that prioritizes the patient experience alongside other system-wide transformation goals, such as cost-savings and efficiency. Knowing whether a given policy or model of care truly embodies the spirit of patient-first care can be difficult, but USofCare offers a framework for policymakers and stakeholders, Patient First Care Principles, for assessing a given model’s fidelity to centering patients.

The patient-first care framework can be seen in the Guiding an Improved Dementia Experience (GUIDE) Model, a model under the CMS Innovation Center (CMMI), which is focused on improving care for dementia patients while supporting caregivers. Unfortunately, approximately twice as many women have Alzheimer’s, the most common form of dementia, compared to men. As such, success for this model has significant implications for improving women’s health – both at the patient and caregiver levels. The model encompasses care coordination between the patient, caregiver, and physician with the help of a care navigator, and moves away from fee-for-service payment and adopts bundled per-member per-month payments covering comprehensive services and promoting accountability through patient-centric evaluation criteria, including two patient-reported outcome measures. The GUIDE Model exemplifies how patient-first care can transform healthcare delivery by centering the well-being of the patient.

The Promise of Payment Reform in Combatting the Maternal Health Crisis

This briefing ended with Dr. Carol Sakala from the National Partnership for Women & Families (NPWF), discussing implications of alternative payment programs for maternal and newborn health outcomes. NPWF conducted a comprehensive landscape study on maternity care alternative payment models, and aligned its extensive recommendations with priorities of birth justice leaders. These priorities include various elements of “person-first” care, emphasizing using payment to support equity, prioritizing quality over costs and building a more culturally congruent workforce with more midwives and doulas. However, the paucity of alternative payment models with accountability in the maternal health space is a significant missed opportunity to leverage payments to improve maternal health outcomes. 

On a positive note, CMMI’s Transforming Maternal Health (TMaH) Model is expected to launch in 2025. The Innovation Center will select up to fifteen state Medicaid Agencies and award up to $17 million and extensive technical assistance to each awardee over ten years. The initial three-year pre-implementation period offers crucial opportunities to strengthen states’ maternal health infrastructure. This model will increase access to high-performing maternal care models such as midwifery, doula support, and birth centers. Among other required activities are risk assessments, screenings, and support as appropriate for depression, anxiety, SUD, and health-related social needs. Through care coordination and payment reform, this value-based care model is expected to improve maternal and child health outcomes in TMaH states and should have favorable spillover effects elsewhere.

Improving Women’s Health Across the Lifespan Means Embracing Payment Reform

It’s clear that accountable, patient-first care can positively impact women’s health across their lifespan. Accountable care provides a clear opportunity to improve health outcomes and experiences, especially for women.

Patient-first care models should adopt a core set of patient-reported quality measures across payers and populations to fully capture the patient’s perspective. The data collected from these metrics should be used to determine whether providers are achieving patient quality and health equity goals.

Patient stories powerfully showcase how two women, at very different points  in life, and with very different health profiles, benefitted from compassionate and coordinated care enabled by accountable care and delivered by providers that could spend more time with their patients, address care for the entire person (not just symptom), and work on a team to provide necessary care. New models unveiled by the CMS Innovation Center demonstrate a commitment to weaving beneficiary experiences and needs into model design, with some meaningful opportunities to improve women’s health. The GUIDE Model, which stands to benefit those finding themselves in the model as a patient with dementia, or caregiver supporting such a patient, presents clear upsides for beneficiaries writ large, especially for women finding themselves in either the patient or caregiving role.   Similarly, the TMaH model takes the maternal health crisis head-on, seeking to improve maternal health outcomes and, in turn, newborn health outcomes. 

Accountable for Health, the National Partnership for Women & Families, and United States of Care are united in calling for advancing payment reforms that stand to improve women’s health across the lifespan. Policymakers, elected officials, regulators, and stakeholders can contribute to improving women’s health by engaging in federal and state payment reform discussions. This could include the following:

1. Members of Congress (and related stakeholders) encouraging their state officials to use the TMaH model framework for better, more equitable maternal care in their state;
   
2. Members of Congress focusing on advancing reforms that will strengthen the nation’s primary care infrastructure and workforce, an entry-point and homebase for care that so many individuals and families rely on; and,
   
3. As Members and stakeholders consider payment reform policy and supporting innovative care models, using the Patient-First Care Principles to ensure you are supporting access to patient-centered and high quality health care.

It is clear that accountable, patient-first care has a place in women’s health and across a woman’s lifespan. The opportunity for improved health outcomes for women is immense, and payment reform provides a straightforward, commonsense approach that policymakers at the federal and state levels ought to embrace.