Transforming Maternal Health: A New CMS Initiative to Support Midwifery-Led Care
The Centers for Medicare & Medicaid Services (CMS) recently announced an exciting new initiative, the Transforming Maternal Health (TMaH) Model. This 10-year program aims to address the urgent maternal health crisis in the United States by investing in innovative, comprehensive care approaches that support the well-being of birthing people and their families. This initiative represents a significant step forward in recognizing the vital role of midwifery in improving maternal health outcomes, especially in underserved communities.
The Urgent Need for Reform
Despite being one of the wealthiest countries in the world, the United States faces a dire maternal health crisis. The Centers for Disease Control and Prevention (CDC) recently reported that the overall maternal mortality rate increased from 2019 to 2020 in the United States, from 754 to 861 deaths per 100,000 live births. Alarmingly, the maternal mortality rate for Black women increased 26 percent during that time, from 44 deaths per 100,000 live births to over 55 in 2020. This worsening statistic is evidence of a failing health care system that does not cater to the unique needs of women and birthing people.
The United States has a health care system that rewards quantity of services over quality, and this ethos is embedded in how the system handles payment and delivery. Currently, fee-for-service is the primary payment method in the United States health care system. Under a fee-for-service model, doctors and other health care providers are paid a fee for each particular service rendered, which ultimately rewards providers for the volume and quantity of services. For example, hospitals are currently being paid $9,000 more for cesarean sections than vaginal births. Cesarean sections are a primary example of how financial incentives do not align with effective maternity care and why reforming fee-for-service must be a priority.
Core Objectives of the TMaH Model
The TMaH Model is a groundbreaking program designed to improve maternal health outcomes through a whole-person approach to care. It prioritizes the integration of physical, mental, and social health needs during pregnancy and postpartum. The program provides up to $17 million in funding per state to implement strategies that:
- Expand access to midwifery and doula services.
- Increase the availability and capacity of maternal health care providers.
- Address systemic inequities in maternal health care delivery.
- Reduce maternal morbidity and mortality, particularly among underserved and high-risk populations.
By prioritizing holistic and culturally sensitive care models, participating states aim to tackle persistent disparities in maternal health outcomes. These states will receive federal support to enhance maternal health care through evidence-based strategies, including the integration of midwifery-led care.
Participating States
Fifteen states have been selected as participants in the TMaH Model to lead these transformative efforts:
| Participating States |
|---|
| Alabama, Arkansas, California, District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, Wisconsin |
The Strength of Midwifery and Value-Based Care
The TMaH Model’s emphasis on expanding midwifery and doula services marks a pivotal moment for maternal health advocacy. Certified Professional Midwives (CPMs) are uniquely equipped to deliver the kind of individualized, patient-centered care that this initiative seeks to promote. By investing in midwifery-led models of care, the TMaH Model aligns with research showing that midwives can significantly reduce maternal and neonatal morbidity and mortality while improving overall patient satisfaction.
To improve outcomes—particularly in maternal health—the United States must adopt a health care payment system that accounts for the actual value of care provided. Unlike fee-for-service, value-based care programs consider the quality of care and only provide reimbursements if quality and patient experience measures are met. Value-based programs were created as an alternative to the fee-for-service model, with the goal of providing patients with quality care while reducing the per-capita cost of health care.
The funding and support offered through the TMaH Model will enable states to train and certify more midwives and doulas and support midwifery-led practices that prioritize the autonomy and agency of birthing individuals. As advocates for midwifery-led care, NACPM urges all stakeholders to seize this opportunity to elevate the midwifery profession and ensure every family has access to the care they deserve.