Postpartum Care and the Provision of Effective Postpartum Contraceptive Methods in California's Medicaid Program

Postpartum care is an important opportunity for assessment of a woman’s health following delivery. One important component of postpartum care is discussion and potential provision of postpartum contraception, which can enable optimal birth spacing that supports healthy maternal and infant health outcomes. The HEDIS Postpartum Care Rate Measure defines postpartum care as pelvic exams or visits focused on postpartum health that occur 21 to 56 days after delivery. Although discussing contraception is an important component of postpartum care, most billing codes for family planning visits do not satisfy the HEDIS measure. We used administrative data from California’s Medicaid program, Medi-Cal, to identify deliveries, assess the type of postpartum visit received, and find evidence of contraceptive dispensing up to 90 days after delivery. Of 247,657 Medi-Cal deliveries between November 6, 2011 and November 5, 2012, 47.3% had a claim for a HEDIS-defined postpartum visit, an additional 7% had a family planning office visit, and 19.7% were seen for other medical reasons. Contraceptive claims were found for half of women with a postpartum visit and 73.3% of women with a family planning office visit. Only 20.8% of women who were seen for other medical reasons received contraception. We will describe the demographics of women who received contraceptives following a postpartum office visit, and further examine the scope of services received. The findings suggest that there are opportunities to both increase postpartum contraceptive use and encourage clinicians to take advantage of opportunities to inquire about or refer women for postpartum care.