Provider Notice issued 09/29/15

Postpartum Visits and Perinatal Care Transitions

The purpose of this notice is to outline the department’s policy for postpartum visits, encourage providers to educate women on the importance of postpartum care, share best practices and expectations related to perinatal care transitions, and provide resources to assist in transitioning patients between providers and across settings. Care transition is the movement of patients from one health care practitioner or setting to another as their condition and care needs change, ensuring coordination and continuity of care. Accurate and timely communication is the cornerstone to care transitions which greatly impacts quality patient centered care and patient safety.

For the last several years, Illinois Department of Healthcare and Family Services (HFS) covered almost 55% of the State’s births and 95% of all teen births; and of those total births, 60% were unintended. This data and the following data were reported in the 2014 Illinois Perinatal Report to the General Assembly and demonstrates great room for improvement:

• 55% received postpartum care between 3 weeks and 6 weeks

• 60% received family planning services within 6 months after delivery

• 56% are second or higher level births and about 25% of these subsequent births occur within 18 months

• 43% of births were non-normal (i.e., prematurity, low birth weight, very low birth weight, infant mortality)

The transition from delivery/postpartum care in the hospital setting to outpatient postpartum care is one of several transitions that occur during the perinatal period. The postpartum visit should be scheduled or confirmed prior to hospital discharge and discharge instructions should include the appointment date, time and location. Assuring that women receive a postpartum visit is a key strategy to improve birth outcomes. The postpartum visit allows for a physical exam, supportive guidance on healthy behaviors, assessment of health conditions, including depression, preconception counseling, and reproductive life planning, including discussion/initiation of birth control, if not previously initiated. These interventions can help women prevent or plan for safer future pregnancies, address chronic health conditions, and space pregnancies to allow for full physical recovery from a previous pregnancy, thereby reducing unintended pregnancies and improving future birth outcomes.

The postpartum visit is an essential component in the continuum of well-woman care and assuring that women receive a postpartum visit is a key strategy to improve birth outcomes. HFS policy allows reimbursement for one comprehensive postpartum visit. Additional visits for related issues outside the routine postpartum visit are also payable if supported with appropriate coding/documentation.

The transition from postpartum care to primary care is critical. The postpartum provider should ensure that women are linked back to their primary care provider (PCP) after the postpartum visit. This is especially important if the patient was diagnosed with hypertension, diabetes or other medical conditions or complications during pregnancy, or has preexisting co-morbidities. If the PCP is unknown, a Quick Reference Tool is available to assist in identifying the patient’s PCP.

The following chart depicts the various transitions that occur during perinatal care, including the transition from postpartum care to ongoing primary care. Successful transitions across providers and care settings assure the continuum of well-woman care.

Continuum of Well-Woman Care

Successful care transitions include information sharing/communication, logistical arrangements/care coordination, and patient and family education/engagement. In light of our complex health care system, assisting women through care transitions supports continuity and optimizes health outcomes for women and their families. Successful care transitions involve a multidisciplinary team and ongoing collaboration with care coordination entities (e.g., managed care plans). And most importantly, pregnant women who are considered high risk should be identified early and closely monitored within a robust care transition system.

As HFS continues to roll-out its new care coordination delivery system, more emphasis will be placed on care transitions. A best practices checklist for perinatal care transitions, adapted from national recommendations, can assist providers and staff in adopting strategies to improve the safety and quality of perinatal care transitions.

Felicia F. Norwood

Director