Comparing Postpartum Care Utilization from Medicaid Claims and the Pregnancy Risk Assessment Monitoring System in Wisconsin, 2011–2015

Abstract

Objective

To compare two data sources from Wisconsin—Medicaid claims and Pregnancy Risk Assessment Monitoring System (PRAMS) surveys—for measuring postpartum care utilization and to better understand the incongruence between the sources.

Methods

We used linked Medicaid claims and PRAMS surveys of Wisconsin residents who delivered a live birth during 2011–2015 to assess women’s postpartum care utilization. Three different definitions of postpartum care from Medicaid claims were employed to better examine bundled service codes and timing of care. We used one question from the PRAMS survey that asks women if they have had a postpartum checkup. Concordance between the two data sources was examined using Cohen’s Kappa value. For women who reported having a postpartum checkup on PRAMS but did not have a Medicaid claim for a traditional postpartum visit, we determined the other types of health care visits these women had after delivery documented in the Medicaid claims.

Results

Among the 2313 women with a Medicaid-paid delivery and who completed a PRAMS survey, 86.6% had claims for a postpartum visit during the first 12 weeks postpartum and 90.5% self-reported a postpartum checkup on PRAMS (percent agreement = 79.9%, Kappa = 0.015). The percent agreement and Kappa values varied based on the definition of postpartum care derived from the Medicaid claims data.

Conclusions

There was slight agreement between Medicaid claims and PRAMS data. Most women had Medicaid claims for postpartum care at some point in the first 12 weeks postpartum, although the timing of these visits was somewhat unclear due to the use of bundled service codes.

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Acknowledgements

The authors thank the Wisconsin Department of Health Services for sharing the data used in this analysis.

Funding

Carla DeSisto was supported by the University Fellowship from the Graduate College at the University of Illinois at Chicago, and the Hamilton Research Scholarship, the Dr. Sharon L. Telleen Maternal and Child Health Award, and the Maternal and Child Health Epidemiology Doctoral Training Program from University of Illinois at Chicago School of Public Health.

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Correspondence to Carla L. DeSisto.

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Appendix

Appendix

See Table 4.

Table 4 Medicaid codes used to identify postpartum care (Keystone First 2017; National Committee for Quality Assurance 2010; Rankin et al. 2016)

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DeSisto, C.L., Rohan, A., Handler, A. et al. Comparing Postpartum Care Utilization from Medicaid Claims and the Pregnancy Risk Assessment Monitoring System in Wisconsin, 2011–2015. Matern Child Health J (2021). https://doi.org/10.1007/s10995-021-03118-2

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Keywords

  • Postpartum care
  • Medicaid claims
  • PRAMS
  • Epidemiology