Supporting Care During and After Pregnancy

For pregnant and postpartum women, care visits can set the stage for their and their infants’ long-term well-being, according to the American College of Obstetricians and Gynecologists. We encourage you to discuss timely care with our members during and after pregnancy. Resources that may help include our Preventive Care Guidelines and Perinatal Wellness Guidelines.

Closing Care Gaps

Prenatal and Postpartum Care (PPC) is a quality measure developed by the National Committee for Quality Assurance (NCQA) that tracks appopriate screenings. We track data from quality measures to help assess and improve our members’ care.

PPC measures the percentage of live-birth deliveries on or between Oct. 8 of the year before the measurement year and Oct. 7 of the measurement year. It captures:

  • Timeliness of prenatal care, or the percentage of deliveries in which women had a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment with Blue Cross and Blue Shield of Texas
  • Postpartum care, or the percentage of deliveries in which women had a postpartum visit on or between seven and 84 days after delivery

Tips to Consider to Close Care Gaps

  • Discuss with members that it’s important to attend all visits.
  • Schedule initial prenatal visits in the first 12 weeks of pregnancy with an OB/GYN, primary care physician (PCP) or other prenatal practitioner.
  • Be aware that post-operative visits after a Cesarean section within a couple of days of discharge or during an inpatient stay don’t count as a postpartum visit. A postpartum visit must take place on or between seven and 84 days after delivery. It should be scheduled during the Cesarean section post-op visit.
  • Data for this measure is collected from claims and chart review, with services being performed by an OB/GYN, midwife, family practitioner or other PCP:
    • When documenting a prenatal visit, include diagnosis of pregnancy, last menstrual period or estimated date of delivery, prenatal risk assessment, complete obstetrical history, fetal heart tone and screening tests. Telehealth visits can be considered in meeting this requirement.
    • When documenting a postpartum visit, notate postpartum care, check or six-week check. Document the pelvic exam and evaluation of weight, blood pressure, breasts, and abdomen.

 

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.