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Clarity Performance Solutions logo in brand colors of grey, dark blue and light blue.

MEMBER ENGAGEMENT

Medicare’s Maternal Care Challenge

Rethinking Prenatal & Postpartum Engagement for Medicare Members

When it comes to maternal care, timing is everything. Prenatal and postpartum visits are critical for ensuring both maternal and infant health, yet Medicare plans struggle with engagement and compliance in these crucial touchpoints. Despite full coverage, too many Medicare members miss essential visits, leading to higher risks of complications, increased costs, and lower HEDIS scores for health plans.For payers and TPAs, the challenge isn’t just ensuring these visits happen—it’s reaching the right members at the right time with messaging that drives action. Traditional outreach methods often fall short, leaving plans scrambling to close gaps that could have been prevented with smarter engagement strategies.

The Maternal Care Gaps

Medicare plans covering pregnant and postpartum members face several structural and behavioral barriers that impact HEDIS compliance:
1. Missed Prenatal Appointments Lead to Higher Risks & Costs
  • The first prenatal visit sets the stage for a healthy pregnancy. Early detection of hypertension, gestational diabetes, and high-risk conditions can prevent costly complications, yet many Medicare members delay or skip these visits entirely.
  • A missed first trimester visit increases the risk of pregnancy-related complications, leading to preventable hospitalizations and higher claim costs.
2. Postpartum Engagement Is Often an Afterthought
  • HEDIS measures track postpartum checkups within 7-84 days after delivery, yet outreach efforts often decline after birth. This gap in engagement means missed opportunities to address postpartum depression, complications, and long-term health risks.
  • Without structured postpartum care, many members fall through the cracks—leading to avoidable readmissions and higher healthcare expenditures.
3. Medicare Populations Face Unique Engagement Barriers
Unlike commercial or Medicaid populations, Medicare beneficiaries in maternal care programs often navigate additional obstacles including:
  • Confusion about coverage – Members may not realize that prenatal and postpartum visits are fully covered under Medicare.
  • Lack of digital access – Traditional engagement methods, like mailed letters, may not effectively reach them in time.
  • Competing health priorities – Members managing chronic conditions may deprioritize prenatal and postpartum care, increasing risks.
  • The result? Lower adherence, reduced quality scores, and rising costs for health plans.

Turning Engagement Into Action: What Payers Can Do Differently

To close Medicare’s maternal care gaps, health plans need a proactive, personalized approach to member engagement. Here’s what works:
1. Identify At-Risk Members Before They Miss a Visit
  • Predictive analytics can pinpoint Medicare members at higher risk of missing critical prenatal or postpartum care based on claims history, previous engagement patterns, and social determinants of health (SDOH).
  • This allows plans to prioritize outreach to those most likely to fall behind—before non-compliance happens.
2. Use Tailored, Multi-Channel Communication
  • Not all members respond to generic reminders. A multi-channel approach—integrating text messages, live call outreach, and caregiver notifications—can significantly improve compliance.
  • A personalized text with a direct scheduling link is more effective than a mailed reminder that arrives too late.
3. Address Logistical Barriers in Real-Time
  • For many Medicare members, the issue isn’t awareness—it’s access. Providing transportation assistance, flexible scheduling, and telehealth options can dramatically improve follow-through.
  • A member who knows a ride is available is far more likely to keep their appointment.

The Clarity Solution: Smarter Engagement, Stronger Outcomes

Closing HEDIS gaps for maternal care isn’t just about compliance—it’s about better health outcomes, cost savings, and operational efficiency. Clarity’s Member Engagement platform helps payers tackle these challenges head-on with:
  • Predictive analytics to identify at-risk members before gaps occur
  • Automated, personalized engagement tailored to Medicare maternal health needs
  • Multi-channel outreach that increases response rates and drives action
  • Real-time barrier resolution—from transportation to scheduling support
The result? Higher HEDIS scores, healthier members, and reduced costs for payers.Want to see how Clarity can help close your plan’s maternal care gaps? Let’s talk.

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